PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Health Insurance Benefit Agreement and Supporting Regulations at 42 CFR Part 489 and 491
Modified
2400
400
0
Form and Instruction
CMS-1561
Health Insurance Benefits Agreement
Form and Instruction
CMS-1561A
Health Insurance Benefits Agreement for RHC
Total burden requested under this ICR:
2400
400
0
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