Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
REQUEST FOR CERTIFICATION AS A SUPPLIER OF PORTABLE X-RAY SERVICES UNDER THE MEDICARE/MEDICAID PROGRAM AND PORTABLE X-RAY SURVEY REPORT Migrated 250 438 0 Form 1882
Form HCFA-1880
Total burden requested under this ICR: 250 438 0  
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