Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
EOB	New	6768	97760	0	Form and Instruction	CMS-10453	Example of HMO Monthly Summary
					Form and Instruction	CMS-10453	HMO Quarterly Summary
					Form and Instruction	CMS-10453	HMO Monthly
					Form and Instruction	CMS-10453	MSA Monthly EOB
					Form and Instruction	CMS-10453	MSA Quarterly Summary
					Form and Instruction	CMS-10452	PFFS monthly EOB
					Form and Instruction	CMS-10453	PFFS quarterly summary
					Form and Instruction	CMS-10453	PPA Monthly EOB
					Form and Instruction	CMS-10453	PPO quarterly summary
Total burden requested under this ICR:		6768	97760	0
To view an IC, click on IC Title