Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Health Coverage and Help Paying Costs Short Form Modified 532800 266400 0 Form and Instruction CMS-10440
Individual Application Modified 4795200 815184 0 Form and Instruction CMS-10440
Form and Instruction CMS-10440
Form and Instruction CMS-10440
Total burden requested under this ICR: 5328000 1081584 0  
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