Waiver Application for Providers and Suppliers Subject to an Enrollment Moratorium (CMS-10629)

OMB 0938-1313

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10629 Waiver Application Form and Instruction
CMS-10629 - Supporting Statement for Enrollment Moratorium - Final 523.docx Supporting Statement A
Waiver Application Form and Instruction

All Historical Document Collections

201703-0938-007 Approved with change	Reinstatement without change of a previously approved collection	2017-03-07
201608-0938-002 Approved without change	New collection (Request for a new OMB Control Number)	2016-08-04