Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Use Agreement New 50 50 0 Form and Instruction Form #2
Health Plan Information New 280 140 0 Form and Instruction Form #3
Registration Form and Data Submission New 70 532 0 Form and Instruction Form #1
Total burden requested under this ICR: 400 722 0  
To view an IC, click on IC Title