Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Beneficiaries New 36982 9246 0 Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program
Pharmacists (Fax the Documentation to the LI NET Sponsor) New 36722 1223 0
Sponsor (Report to CMS) New 36982 1232 0
Total burden requested under this ICR: 110686 11701 0  
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