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CMS-1763 - Supporting Statement A (CMS-4199-F version 6)
CMS-1763 - Supporting Statement A (CMS-4199-F version 6).docx
Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage (CMS-1763)
OMB: 0938-0025
OMB.report
HHS/CMS
OMB 0938-0025
ICR 202210-0938-007
CMS-1763 - Supporting Statement A (CMS-4199-F version 6)
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0025 can be found here:
2025-08-05 - Reinstatement with change of a previously approved collection
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