Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Change of Ownership (Private) Modified 42 42 0
Change of Ownership (Public) Modified 33 33 0
Data Inaccuracies (Private) Modified 2063 181544 0
Data Inaccuracies (Public) Modified 1688 148544 0
Early Retiree Reinsurance Program - Private Application Modified 4125 90750 0
Early Retiree Reinsurance Program - Public Application Modified 3375 74250 0
Fraud and Abuse Procedures (Private) - Out Years Modified 1032 20640 0
Fraud and Abuse Procedures (Private) - Year 1 Modified 2064 41280 0
Fraud and Abuse Procedures (Public) - Out Years Modified 844 16880 0
Fraud and Abuse Procedures (Public) - Year 1 Modified 1688 33760 0
Mainenance of Records (Private) Modified 4125 24750 0
Maintenance of Records (Public) Modified 3375 20250 0
Reimbursement Requests (Private) Modified 8250 726000 0
Reimbursement Requests (Public) Modified 6750 594000 0
Written Agreements (Private ) - Year 1 Modified 16500 16500 0
Written Agreements (Private) - Out Years Modified 1032 1032 0
Written Agreements (Public) - Out Years Modified 844 844 0
Written Agreements (Public) - Year 1 Modified 13500 13500 0
Total burden requested under this ICR: 71330 2004599 0  
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