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