PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Request for Termination of Premium-Hospital and or Supplementary Medical Insurance and Supporting Regulations in 42 CFR Sections 406.13 and 407.27
Modified
14000
5831
0
Form
CMS-1763
REQUEST FOR TERMINATION OF PREMIUM HOSPITALAND/OR SUPPLEMENTARY MEDICAL INSURANCE
Total burden requested under this ICR:
14000
5831
0
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