Information Collection List

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