PRA IC List
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Agenda
Reg Review
ICR
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
CMS-10440 - Attachment B - Application for Health Coverage & Help Paying Costs (Short Form)
Individual Application
Modified
4884000
2205614
0
Instruction
Form and Instruction
CMS-10440
Application for Health Coverage & Help Paying Costs (Short Form)
Form and Instruction
CMS-10440
Application for Health Coverage & Help Paying Costs
Form and Instruction
CMS-10440
Application for Health Coverage (no cost help)
Total burden requested under this ICR:
4884000
2205614
0
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