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
Individual Application Modified 4195800 713286 0 Form and Instruction CMS-10440
Form and Instruction CMS-10440
Form and Instruction CMS-10440
Form and Instruction CMS-10440
Total burden requested under this ICR: 4662000 946386 0  
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