Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Collection of Dental Benefit Information Modified 51 1275 0 Form CMS-10291
Other-Screenshot: Summary of Benefits Form
Collection of Dental Provider Information Modified 204 10506 0 Form and Instruction CMS-10291
Total burden requested under this ICR: 255 11781 0  
To view an IC, click on IC Title