Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Files Submission Modified 340 340 0 Form and Instruction Form #4 Screen Shots of Data Submission
Data Use Agreement Modified 75 4 0 Form and Instruction Form #2 Data Use Agreement
Health Plan Information Modified 300 150 0 Form and Instruction Form #3 Health Plan Information Form
Registration Form and Data Submission Modified 85 7 0 Form and Instruction 1 Attachment D: Registration Form
Total burden requested under this ICR: 800 501 0  
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