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 3 0 0 Instruction
Form A 42 CFR 83.9 Modified 2 0 0 Instruction
Form B 42 CFR Part 83.9 Modified 5 25 0 Form none Form B
Petitioner Appealing Final Decision under 42 CFR 83.18 Modified 2 10 0 Instruction
Petitioner Submission Format other than Form B 42 CFR 83.9 Unchanged 1 6 0 Instruction
Total burden requested under this ICR: 13 41 0  
To view an IC, click on IC Title