Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
State Annual Long-Term Care Ombudsman Report	Modified	52	11153	0	Form and Instruction	NA	Table 1
					Form and Instruction	NA	Table 2
					Form and Instruction	NA	Table 3
Total burden requested under this ICR:		52	11153	0
To view an IC, click on IC Title