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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Pharmacies Outpatient Prescription Pharmaceuticals
New
1060
18
0
Other-Electronic Claims Submission
Responder Appeals Certification of Health Conditions
New
1
1
0
Other-Letter
Responder Appeals Treatment
New
14
7
0
Other-Letter
Responder Appeals to Eligibility Denial
New
4
2
0
Other-Letter
Responder Eligibility Application
New
1605
803
0
Form and Instruction
none
Eligibility Application
Responder Travel Refund Request
New
1
0
0
Form
none
Travel Refund Request
Total burden requested under this ICR:
2685
831
0
To view an IC, click on IC Title
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The .gov means it's official.
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