Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
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
Form and Instruction
CMS-1696
Appointment of Representative (Spanish Version)
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
Form and Instruction
CMS-1696
Appointment of Representative (Spanish Version)
Total burden requested under this ICR:
265481
66370
0
To view an IC, click on IC Title