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
Application for Health Coverage and Help Paying Costs Short Form
Modified
466200
233100
0
Form and Instruction
CMS-10440
CMS-10440 - Attachment B - Application for Health Coverage & Help Paying Costs (Short Form)
Individual Application
Modified
4195800
713286
0
Form and Instruction
CMS-10440
CMS-10440 - Attachment A-Individual Online Application Questionnaire
Form and Instruction
CMS-10440
Attachment C - Paper Application - FA Family, plus appendices
Form and Instruction
CMS-10440
Paper Application - non-FA, plus appendices
Form and Instruction
CMS-10440
Electronic Questionnaire Additional Items
Total burden requested under this ICR:
4662000
946386
0
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