Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medical Source Statement of Ability To Do Work-Related Activities: Physical and Mental Modified 200000 50000 0 Form HA-1151 MEDICAL SOURCE STATEMENT OF ABILITY TO DO WORK-RELATED ACTIVITIES (PHYSICAL)
Form HA-1151 09-05 EDITION Medical Source Statement of Ability To Do Work-Related Activities (Physical)
Total burden requested under this ICR: 200000 50000 0  
To view an IC, click on IC Title