Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Beneficiaries Modified 36982 9246 0 Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (English)
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (English))
Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Chinese))
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Chinese)
Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Korean))
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Korean))
Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Spanish)
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Income Newly Eligible Transition (LI NET) Program (Spanish)
Form and Instruction CMS-10831 Application to Enroll in the Limited Income Newly Eligible Transition (LI NET) Program (Vietnamese)
Form and Instruction CMS-10831 Direct Reimbursement Request for the Limited Inon (LI NET) Program ()come Newly Eligible Transition(Vietnamese)
Pharmacists (Fax the Documentation to the LI NET Sponsor) Unchanged 36722 1223 0
Sponsor (Report to CMS) Unchanged 36982 1232 0
Total burden requested under this ICR: 110686 11701 0  
To view an IC, click on IC Title