OMB control number

Analysis of Transportation Barriers to Utilization of Medicare Services by American Indian and Alaska Native Medicare Beneficiaries

OMB 0938-1182 · HHS/CMS.

OMB 0938-1182

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10399 Survey Form and Instruction
CMS-10399 Supporting Statement Part B v5 CLEAN_rev10-15-12.pdf Supporting Statement B
CMS Transportation Barriers Crosswalk.pdf Supplementary Document
CMS-10399 Supporting Statement Part A v5 CLEAN_rev_10-15-12.pdf Supporting Statement A
Survey Form and Instruction

All Historical Document Collections

201204-0938-005

2012-04-26