Form 1 Monthly Enrollment

OMB Control No: 0970-0427
Expiration date: X/XX/XXXX

Monthly Enrollment

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) Public reporting burden for this
collection of information is estimated to average 0.05 hours per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.

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