Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Submission Modified 150 150 0 Form Form #4
Data Use Agreement Modified 150 8 0 Form and Instruction Form #2
Eligibility Form Modified 150 8 0 Form Form #1
Medical Office Information Form Modified 1500 125 0 Form Form #3
Total burden requested under this ICR: 1950 291 0  
To view an IC, click on IC Title