Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
SHOP - Employer New 177777 36089 0 Form and Instruction CMS-10439 Appendix A SHOP Employer Questionnaire
Form and Instruction CMS-10439 Appendix B SHOP Employer Application
Total burden requested under this ICR: 177777 36089 0  
To view an IC, click on IC Title