Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Beneficiary) Modified 26548 6637 0 Form and Instruction CMS-1696 Appointment of Representative
Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Provider Supplier) Modified 238933 59733 0 Form and Instruction CMS-1696 Appointment of Representative
Total burden requested under this ICR: 265481 66370 0  
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