Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Submission Modified 40 40 0 Form and Instruction Form #4
Data Use Agreement Modified 40 2 0 Form and Instruction Form #2
Eligibility/Registration Form Modified 40 2 0 Form and Instruction Form #1
Nursing Home Site Information Form Modified 200 17 0 Form Form #3
Total burden requested under this ICR: 320 61 0  
To view an IC, click on IC Title