Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170) New 1500 226500 0 Other-TRK Changes
Other-Trk Change
Instruction
Other-Payment Set-Up (CMS-10170)
Retiree Drug Subsidy (RDS) Payment Request and Instructions (CMS-10170) Modified 3000 453000 0 Other-TRK Changes
Other-Trk Change
Instruction
Other-Payment Set-Up (CMS-10170)
Total burden requested under this ICR: 4500 679500 0  
To view an IC, click on IC Title