Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Enrollment in Supplementary Medical Insurance and Supporting Regulations in 42 CFR 407.10 & 407.11 Modified 10000 2500 0 Form CMS-4040
Form CMS-4040 SP
Total burden requested under this ICR: 10000 2500 0  
To view an IC, click on IC Title