Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Monthly Data Reports Modified 150 1500 0 Form and Instruction CMS-10515 CMS Enrollment Payment Data Template
Monthly Data Submission Accuracy Certification Form Modified 150 25 0 Form and Instruction CMS-10515 Monthly Data Submission Accuracy Certification Form
Total burden requested under this ICR: 300 1525 0  
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