OMB control number

Request To Adjust Customary Charge Screen

OMB 0938-0206 · HHS/CMS.

OMB 0938-0206

Latest Forms, Documents, and Supporting Material

Document Name
REQUEST TO ADJUST CUSTOMARY CHARGE SCREEN Form

All Historical Document Collections

198504-0938-006 Approved without change	Revision of a currently approved collection	1985-04-10
198501-0938-002 Approved without change	Reinstatement with change of a previously approved collection	1985-01-24
198402-0938-003 Approved without change	Reinstatement with change of a previously approved collection	1984-02-29
198111-0938-010 Approved without change	New collection (Request for a new OMB Control Number)	1981-11-19