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
Model Notice to HHS
New
64405
109
0
Form and Instruction
CMS-10653
Notice of Availability of Separate Payments for Contraceptive Services
Notice of Availability of Separate Payments for Contraceptive Services
New
210265
68
0
Form and Instruction
CMS-10653
Notice to Enrollees
Self-Certification & Notice to HHS
New
5
4
0
Form and Instruction
CMS-10653
Certification Form
Total burden requested under this ICR:
274675
181
0
To view an IC, click on IC Title
An official website of the United States government
The .gov means it's official.
The site is secure.
