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... Modified 5123 2787 0 Form and Instruction CMS-370
Form and Instruction CMS-377
Form and Instruction CMS-378
Total burden requested under this ICR: 5123 2787 0  
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