Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Submission Modified 300 300 0 Form and Instruction Form #4
Data Use Agreement Modified 300 15 0 Form and Instruction Form #2
Eligibility/Registration Form New 300 15 0 Form and Instruction Form #1
Eligibility/Registration Forms Removed 0 0 0 Form Form #1
Nursing Home Site Information Form Modified 1500 125 0 Form Form #3
Total burden requested under this ICR: 2400 455 0  
To view an IC, click on IC Title