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
Data Use Agreement New 85 4 0 Form and Instruction Form #2
Eligibility/Registration Forms New 85 4 0 Form Form #1
Nursing Home Site Information Form New 425 35 0 Form Form #3
Total burden requested under this ICR: 680 511 0  
To view an IC, click on IC Title