Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Provider Enrollment Form	Modified	48242	6417	17736	Form and Instruction	OWCP-1168	Provider Enrollment Form
Provider Enrollment Form	Modified	48242	6417	17736	Form and Instruction	OWCP-1168	Provider Enrollment Form
Total burden requested under this ICR:		48242	6417	17736
To view an IC, click on IC Title