Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies Modified 4000 667 0 Form and Instruction CMS-10190 6043 Costsharing Preprint
State Plan preprints to implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies (CMS-10190) Modified 16 32 0 Form and Instruction CMS-10190 DRA 6041 Costsharing Preprint
Form and Instruction CMS-10190 DRA 6042 costsharing preprint
Form and Instruction CMS-10190 nem3 1d
Form and Instruction CMS-10190 Non-Emergency Medical Transportation preprint
Form and Instruction CMS-10190 6044 Benchmark Preprint
Total burden requested under this ICR: 4016 699 0  
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