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pdfPRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0938-0921. The time required to complete this
information collection is estimated to average 12 annual hours per response, including the time to
review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security
Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850.
| File Type | application/pdf |
| File Title | According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it |
| Author | CMS |
| File Modified | 2015-07-02 |
| File Created | 2015-07-01 |