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
Request for Termination of Premium Part A, Part B, or Part B Immunosuppressive Drug Coverage
Modified
197518
33578
0
Form and Instruction
CMS-1763
Request for Termination of Premium Part A, Part B or Part B Immunosuppressive Drug Coverage
Form and Instruction
CMS-1763A
Request to Cancel Medicare Part B (Medical Insurance)
Total burden requested under this ICR:
197518
33578
0
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