OMB control number

Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators (CMS-10821)

OMB 0938-1425 · HHS/CMS.

OMB 0938-1425

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10821 Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators Form
CMS-10821.Supporting Statement Part A (final rule).docx Supporting Statement A
Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators Form

All Historical Document Collections

202212-0938-003 Approved without change	New collection (Request for a new OMB Control Number)	2022-12-02
202207-0938-017 Comment filed on proposed rule	New collection (Request for a new OMB Control Number)	2022-07-28