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
Individual Application
Modified
5031000
2345999
0
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)
Form
CMS-10440
Electronic application.
Total burden requested under this ICR:
5031000
2345999
0
To view an IC, click on IC Title
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The .gov means it's official.
The site is secure.
