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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Data Files Submission
Modified
300
300
0
Form and Instruction
Form #4
Screen Shots of Data Submission
Data Use Agreement
Modified
75
6
0
Form and Instruction
Form #2
Data Use Agreement
Health Plan Information
Modified
300
150
0
Form and Instruction
Form #3
Health Plan Submission
Registration Form and Data Submission
Modified
85
7
0
Form and Instruction
1
Attachment D: Registration Form
Total burden requested under this ICR:
760
463
0
To view an IC, click on IC Title