Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application for Health Coverage and Help Paying Costs Short Form Removed 0 0 0 Form and Instruction CMS-10440
Individual Application Modified 4884000 2205614 0 Instruction
Form and Instruction CMS-10440
Form and Instruction CMS-10440
Form and Instruction CMS-10440
Total burden requested under this ICR: 4884000 2205614 0  
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