Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Ambulatory Surgical Center (ASC) Health Insurance Benefits Agreement Form, Request for Certification, Survey Report and Supporting Regulations in 42 CFR 416.41, 416.43, 416.47, and... Migrated 4312 2381 0 Form CMS-377
Form CMS-R-54
Form CMS-378
Form CMS-370
Total burden requested under this ICR: 4312 2381 0  
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