Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claim, Authorization & Invoice for Prosthetic Items & Services Modified 71200 5738 0 Form 10-0103 VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations
Form 10-1394 APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
Form and Instruction 10-2421 PROSTHETIC AUTHORIZATION FOR ITEMS OR SERVICES
Form FL 10-90 Request to submit Quotation
Form VA Form 10-2914 Prescription and Authorization for Glasses
Form VA Form 10-2520 Prosthetic Service Card Invoice
Total burden requested under this ICR: 71200 5738 0  
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