Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Authorization and Invoice for Medical and Hospital Services; Claim for Payment of Unauthorized Medical Services; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle Migrated 1 29671 0 Form 10-7078
Form 10-583
Form 10-2511
Total burden requested under this ICR: 1 29671 0  
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