CMS-10816 Eligibility Screener Questionnaire
Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816)
Attachment C - Eligibility Screener Questionnaire CMS-10816_508
Invitation & Screening
OMB: 0938-1440
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1440 can be found here:
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