Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Client Contact Form New 1621223 135102 0 Form CMS-10028
Public and Media Activity Report Form (PAM) New 51177 4265 0 Form CMS-10028
RESOURCE REPORT New 54 108 0 Form CMS-10028
State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Form, and Resource Report Removed 0 0 0 Form CMS-10028-A
Instruction
Form CMS-10028-C
Form CMS-10028-B
Instruction
Instruction
Total burden requested under this ICR: 1672454 139475 0  
To view an IC, click on IC Title