Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Three-Year Network Adequacy Review for Medicare Advantage Organizations Modified 2495 24632 0 Instruction
Form CMS-10636 Provider Table
Form CMS-10636 Facility Table
Form CMS-10636 Exception Template
Form CMS-10636 Justification Template
Instruction
Total burden requested under this ICR: 2495 24632 0  
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