OMB Paperwork Reduction Disclosure

Public Reporting Burden for this collection of information is estimated to average 1hour per respondent, and includes time required for IPAs to review the instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. IPAs are not required to respond to this collection of information unless a current, valid approved OMB control number is displayed. IPA OMB No. 2577-xxxx, expires xx/xx/xxxx.

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