Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Certification as Supplier of Portable X-Ray and Portable X-Ray Survey Report Form Modified 68 119 0 Form and Instruction CMS-1882 Portable X-Ray Survey Report
Form and Instruction CMS-1880 Request for Certification as Supplier of Portable X-Ray Services Under the Medicare/Medicaid Program
Total burden requested under this ICR: 68 119 0  
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