Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
GenIC #3 - Alternative Benefit Plans (ABPs)	New	56	728	0	Form	CMS-10434 (#3)
GenIC #1 - Initial Application	New	56	476	0	Form	CMS-10434 (#1)
					Form	CMS-10434 (#1)
					Form	CMS-10434 (#1)
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GenIC #2 - CHIP State Plan Eligibility	New	56	1568	0	Form	CMS-10434 (#2)
					Form	CMS-10434 (#2)
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Total Burden Actually Used for Information Collections Under Currently Approved ICR:		168	2772	0
Total Burden Currently Requested for Information Collections Under Currently Approved ICR:		0	0	0
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