PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
STATEMENT OF SUPPORT OF CLAIM FOR EMERGENCY HOSPITAL SERVICE
Migrated
2000
500
0
Form
SSA-1771
Total burden requested under this ICR:
2000
500
0
To view an IC, click on IC Title
An official website of the United States government
The .gov means it's official.
The site is secure.
