Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Notice of Availability of Separate Payments for Contraceptive Services Modified 595307 68 151208 Form and Instruction CMS-10653
Self-Certification & Notice to HHS Modified 5 4 1 Form and Instruction CMS-10653
Total burden requested under this ICR: 595312 72 151209  
To view an IC, click on IC Title