Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Detailed Explanation of Non-Coverage (CMS-10124) Modified 25655 42232 0 Instruction
Form CMS-10124
Form CMS-10124
Notice of Provider Non-Coverage (CMS-10123) Modified 5314194 885699 0 Instruction
Form CMS-10123
Form CMS-10123
Total burden requested under this ICR: 5339849 927931 0  
To view an IC, click on IC Title