Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
REQUEST TO ESTABLISH ELIGIBILITY IN THE MEDICARE AND/OR MEDICAID PROGRAM TO PROVIDE OUTPATIENT PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY SERVICES Migrated 53 462 0 Form 1893
Form HCFA-1856
Total burden requested under this ICR: 53 462 0  
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