Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointment of Representative (Beneficiary) Modified 27054 6764 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Appointment of Representative (Provider Supplier) Modified 243490 60873 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Total burden requested under this ICR: 270544 67637 0  
To view an IC, click on IC Title