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
Request for Termination of Premium-Hospital and/or Supplementary Medical Insurance
Modified
101000
16833
0
Form and Instruction
CMS-1763
Request for Termination of Premium Hospital and/or Supplementary Medical Insurance
Total burden requested under this ICR:
101000
16833
0
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