Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization Form on behalf of Claimant under 42 CFR 83.7 Modified 5 1 0 Instruction
Form A 42 CFR 83.9 Modified 5 1 0 Instruction
Form B 42 CFR Part 83.9 Modified 8 40 0 Form none Form B
Petitioner Appealing Final Decision under 42 CFR 83.18 Modified 4 3 0 Instruction
Petitioner Submission Format other than Form B 42 CFR 83.9 Modified 1 6 0 Instruction
Total burden requested under this ICR: 23 51 0  
To view an IC, click on IC Title