Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Initial Application New 35 17500 0 Form and Instruction CMS-10392
Form and Instruction CMS-10394
Re-application New 25 3000 0 Form and Instruction CMS-10392
Form and Instruction CMS-10394
Total burden requested under this ICR: 60 20500 0  
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