Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage Modified 197518 33578 0 Form and Instruction CMS-1763
Form and Instruction CMS-1763A
Total burden requested under this ICR: 197518 33578 0  
To view an IC, click on IC Title