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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
CA-26, Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs
Modified
500
250
0
Form
CA-26
Authorization Request form and Certification/Letter of Medical Necessity for Compounded Drugs
Form
CA-26 (Method of Administration Detail)
Authorization Request Form and Certification/Letter of Medical Necessity for Compunded Drugs (Methods of Administration Detail
Form
CA-26 (Length of Therapy Detail
Authorization Request Form and Certification/Letter of Medical Necessity for Compunded Drugs (Length of Therapy Detail)
Instruction
Form
CA-26
Authorization Request form and Certification/Letter of Medical Necessity for Compounded Drugs
Form
CA-27
Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
Modified
45100
22550
0
Form and Instruction
CA-27
Authoriization/Request Form and Certification/Letter of Medical Necessity for Opioid Medications
Instruction
Form and Instruction
CA-27 (Web)
Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
Total burden requested under this ICR:
45600
22800
0
To view an IC, click on IC Title