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
Request for Evidence from Doctor or Hospital
Modified
400000
100000
0
Form
HA-67
Request for Evidence from Hospital
Form
HA-66
Request for Evidence from Doctor
Form
Medical Source Billing Form
Medical Source Billing Form
Total burden requested under this ICR:
400000
100000
0
To view an IC, click on IC Title
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