Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Individual Application New 2776698 1407261 0 Form and Instruction CMS-10440 CMS-10440_AttachmentA-Individual Online Application Questionnaire
Form and Instruction CMS-10440 AttachmentC-Application for Health Coverage & Help Paying Costs
Form and Instruction CMS-10440 CMS_10440_AttachmentD-Application for Health Coverage
Application for Health Coverage and Help Paying Costs Short Form New 258736 21561 0 Form and Instruction CMS-10440 CMS-10440.AttachmentB-Application for Health Coverage & Help Paying Costs (Short Form)
Total burden requested under this ICR: 3035434 1428822 0  
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