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Form CMS-10141 Model Precluded Provider Letter
Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)
Attachment 2. Part C and D Model Precluded Provider Letter
Preparation and Issuance of Model Notices (section 423.120(c)(6))
OMB: 0938-0964
OMB.report
HHS/CMS
OMB 0938-0964
ICR 202302-0938-009
IC 231341
Form CMS-10141 Model Precluded Provider Letter
( )
⚠️ Notice: This form may be outdated.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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