Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Employer Coverage Under an Employer Group Health Plan New 800 133 0 Form and Instruction RL-311-F (12-05)
Form and Instruction RL-311-F (proposed)
Medicare Modified 240 32 0 Form and Instruction AA-6 (01-03)
Form and Instruction AA-7 (01-03)
Form and Instruction AA-8 (01-03)
Total burden requested under this ICR: 1040 165 0  
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