Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Appointment of Representative (Beneficiary) Modified 20817 5204 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Form and Instruction CMS-1696 Appointment of Representative (Chinese)
Form and Instruction CMS-1696 Appointment of Representative (Korean)
Form and Instruction CMS-1696 Appointment of Representative (Vietnamese)
Appointment of Representative (Provider Supplier) Modified 187356 46839 0 Form and Instruction CMS-1696 Appointment of Representative (English)
Form and Instruction CMS-1696 Appointment of Representative (Spanish)
Form and Instruction CMS-1696 Appointment of Representative (Chinese)
Form and Instruction CMS-1696 Appointment of Representative (Korean)
Form and Instruction CMS-1696 Appointment of Representative (Vietnamese)
Total burden requested under this ICR: 208173 52043 0  
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