Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointment of Representative (Beneficiary) Modified 21321 5330 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Appointment of Representative (Provider Supplier) Modified 191887 47972 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Total burden requested under this ICR: 213208 53302 0  
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