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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)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Application and Eligibility (2011)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Application and Eligibility (2012)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Application and Eligibility (2013)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Application and Eligibility Burden
New
50000
54500
0
Form and Instruction
CMS-10334
PCIP Application
Premium Payment (2010)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Premium Payment (2011)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Premium Payment (2012)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Premium Payment (2013)
Removed
0
0
0
Form and Instruction
CMS-10334
PCIP Application
Premium Payment Burden
New
33333
5333
0
Form and Instruction
CMS-10334
PCIP Application
Total burden requested under this ICR:
83333
59833
0
To view an IC, click on IC Title
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The .gov means it's official.
The site is secure.
