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
Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Beneficiary)
Modified
26827
6707
0
Form and Instruction
CMS-1696 (English)
Appointment of Representative
Form and Instruction
CMS-1696 (Spanish)
NOMBRAMIENTO DE REPRESENTANTE
Appointment of Representative and Supporting Regulations in 42 CFR 405.910 (Provider Supplier)
Modified
241441
60360
0
Form and Instruction
CMS-1696 (English)
Appointment of Representative
Form and Instruction
CMS-1696 (Spanish)
NOMBRAMIENTO DE REPRESENTANTE
Total burden requested under this ICR:
268268
67067
0
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