Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EOB Modified 1065 10650 0 Form and Instruction CMS-10453 HMO Monthly Template
Form and Instruction CMS-10453 HMO Quarterly Template
Form and Instruction CMS-10453 MSA Monthly Template
Form and Instruction CMS-10453 MSA Quarterly Template
Form and Instruction CMS-10452 PFFS monthly Template
Form and Instruction CMS-10453 PFFS quarterly Template
Form and Instruction CMS-10453 PPO Monthly Template
Form and Instruction CMS-10453 PPO Quarterly Template
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Form and Instruction CMS-10453 Part D EOB Plan Instructions
Total burden requested under this ICR: 1065 10650 0  
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