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
CMS-1500 (02-12)/CMS-1490S
Modified
998032912
17329912
0
Form
CMS-1490S
Health Insurance Common Claim Form (Spanish)
Form
CMS-1490 English
Health Insurance Common Claims Form
Form and Instruction
CMS-1500
CMS-1500 sample
Total burden requested under this ICR:
998032912
17329912
0
To view an IC, click on IC Title
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