Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointment of Representative (Beneficiary) Modified 27054 6764 0 Form and Instruction CMS-1696
Form and Instruction CMS-1696
Appointment of Representative (Provider Supplier) Modified 243490 60873 0 Form and Instruction CMS-1696
Form and Instruction CMS-1696
Total burden requested under this ICR: 270544 67637 0  
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