Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Submission New 85 468 0 Form and Instruction Form #4 NH Welcome and Login Pages
Data Use Agreement New 85 4 0 Form and Instruction Form #2 Data Use Agreement
Eligibility/Registration Forms New 85 4 0 Form Form #1 Eligibility/Registration Forms
Nursing Home Site Information Form New 425 35 0 Form Form #3 Nursing Home Site Information Form
Total burden requested under this ICR: 680 511 0  
To view an IC, click on IC Title