Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Collection of SSN and DOBs Modified 427264 14242 0
Fingerprints - Medicaid Modified 26000 52000 0
Fingerprints - Medicare Modified 45500 91000 0
Medicare Enrollment Application Fee Waiver Request Modified 12000 12000 0
Provider Rescreening Modified 371014 742028 0
Site Visits Modified 5000 40000 0
State Medicaid Agency Processing of Rescreening Application Modified 74203 296812 0
Total burden requested under this ICR: 960981 1248082 0  
To view an IC, click on IC Title