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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Application and Eligibility (2010)
New
100000
84000
0
Application and Eligibility (2011)
New
50000
42000
0
Application and Eligibility (2012)
New
50000
42000
0
Application and Eligibility (2013)
New
50000
42000
0
Premium Payment (2010)
New
50000
8000
0
Premium Payment (2011)
New
33333
5333
0
Premium Payment (2012)
New
33333
5333
0
Premium Payment (2013)
New
33333
5333
0
Total burden requested under this ICR:
399999
233999
0
To view an IC, click on IC Title
An official website of the United States government
The .gov means it's official.
The site is secure.
