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CMS-10141 3b - Exhibit A: Example Cover Page of the Model Part D E
Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)
Attachment 3b. CY 2022 EOB Exhibit A
Medicare Prescription Drug Benefit Program (Plans)
OMB: 0938-0964
OMB.report
HHS/CMS
OMB 0938-0964
ICR 202302-0938-009
IC 187164
CMS-10141 3b - Exhibit A: Example Cover Page of the Model Part D E
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⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0964 can be found here:
2024-12-04 - Revision of a currently approved collection
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