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
Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424 Subpart C
Modified
988005045
21481336
0
Form and Instruction
CMS-1500(08-05)
Health Insurance Claim Form
Form and Instruction
CMS-1490-S
PATIENT'S REQUEST FOR MEDICAL PAYMENT
Total burden requested under this ICR:
988005045
21481336
0
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