Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE New 4000 1000 0 Form 10-1394
Claim, Authorization & Invoice for Prosthetic Items & Services Removed 0 0 0 Form 10-0103
Form 10-1394
Form and Instruction 10-2421
Form FL 10-90
Form VA Form 10-2914
Form VA Form 10-2520
PRESCRIPTION AND AUTHORIZATION FOR FEE BASIS EYEGLASSES New 50000 3333 0 Form 10-2914
PROSTHETIC AUTHORIZATION FOR ITEMS OR SERVICES New 1000 67 0 Form 10-2421
PROSTHETIC SERVICE CARD INVOICE New 700 47 0 Form 10-2520
REQUEST TO SUBMIT QUOTATION New 8500 708 0 Form FL 10-90
VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvements and Structural Alterations New 7000 583 0 Form 10-0103
Total burden requested under this ICR: 71200 5738 0  
To view an IC, click on IC Title