Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CE Claimant/Appointment Letter Information (subset of "CE Forms Samples" category) New 750000 62500 0 Other-Sample of Appointment Letter Included
CE Source Credentialing Information (Subset of "CE Sample Forms") New 3000 750 0 Form and Instruction N/A Sample CE Forms
Claimants re Report to Medical Provider (subset of "CE Forms Samples" category) New 1500000 125000 0 Other-Sample of state DDS Claimant Report Letter/Form
Connect Direct Transmission of MER Information (subset of "MER Samples" category) New 218400 54600 0 Other-Sample MER Information (same as previous IC, submitted through electronic Connect Direct system)
ERE transmission of MER forms (subset of "MER Samples" category) New 100800 11760 0 Other-ERE Transmission of "MER Samples" Category
MER Paper Submissions (subset of "MER Samples") category New 2480800 620200 0 Other-Sample of MER forms
Medical Evidence from CE Providers (Electronic Transmission through ERE; subset of "CE Forms Samples" category) New 285000 71250 0 Other-Sample of types of information sent through ERE; electronic version of CE paper
Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category) Modified 1215000 607500 0 Other-Samples of DDS CE Forms
Total burden requested under this ICR: 6553000 1553560 0  
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