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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Change of Ownership (Private)
New
33
33
0
Change of Ownership (Public)
New
17
17
0
Data Inaccuracies (Private)
New
2000
32000
0
Data Inaccuracies (Public)
New
1000
16000
0
Early Retiree Reinsurance Program - Private Application
New
3000
105000
0
Form
CMS-10321
ERRP Application
Instruction
Early Retiree Reinsurance Program - Public Application
New
1500
52500
0
Form
CMS-10321
ERRP Application
Instruction
Fraud and Abuse Procedures (Private) - Out Years
New
754
15080
0
Fraud and Abuse Procedures (Private) - Year 1
New
6000
120000
0
Fraud and Abuse Procedures (Public) - Out Years
New
371
7420
0
Fraud and Abuse Procedures (Public) - Year 1
New
3000
60000
0
Mainenance of Records (Private)
New
3000
18000
0
Maintenance of Records (Public)
New
1500
9000
0
Reimbursement Requests (Private)
New
6000
270000
0
Reimbursement Requests (Public)
New
3000
135000
0
Written Agreements (Private ) - Year 1
New
9000
9000
0
Written Agreements (Private) - Out Years
New
754
754
0
Written Agreements (Public) - Out Years
New
371
371
0
Written Agreements (Public) - Year 1
New
4500
4500
0
Total burden requested under this ICR:
45800
854675
0
To view an IC, click on IC Title