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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Data Files Submission
New
320
320
0
Form and Instruction
Form #4
Screen Shots of Data Submission
Data Use Agreement
Modified
60
3
0
Form and Instruction
Form #2
Data Use Agreement
Health Plan Information
Modified
320
160
0
Form and Instruction
Form #3
Health Plan Information Form
Registration Form and Data Submission
Modified
80
7
0
Form and Instruction
Form #1
Registration Form
Total burden requested under this ICR:
780
490
0
To view an IC, click on IC Title