Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Initial Application	New	35	17500	0	Form and Instruction	CMS-10392	Qualified Entity Application
Initial Application	New	35	17500	0	Form and Instruction	CMS-10394	Revised QE Application
Re-application	New	25	3000	0	Form and Instruction	CMS-10392	Qualified Entity Application
Re-application	New	25	3000	0	Form and Instruction	CMS-10394	Revised QE Application
Total burden requested under this ICR:		60	20500	0
To view an IC, click on IC Title