Cms-10797 Sep Ui

Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) (CMS-10797)

CAA - SEP UI Mock-ups - 221024

OMB: 0938-1426

Document [pdf]
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SEP UI Mockups
Landing Page with no prior SEP occurrences

Landing Page with 1 prior SEP occurrence

Landing page with 2 prior SEP occurrence

Add SEP Page prior to SEP selection

Add SEP Page with Emergency or Natural Disaster Selected

Add SEP Page with Formerly Incarcerated Individual

Add SEP with Misrepresentation Selected

Add SEP Page with Termination of Medicaid Selected

Add SEP Page with Other Exceptional Conditions Selected

Edit SEP Page when an existing SEP is edited


File Typeapplication/pdf
AuthorTodd Owens
File Modified2022-10-27
File Created2022-10-27

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