Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Additional Documentation and Certification	Modified	30	23	0	Form	F
Authorization for Use or Disclosure of Health Information Form	Modified	100	200	0	Form and Instruction	E
	Modified	100	200	0	Instruction
Benefits Package and Supporting Documentation	Modified	30	4	0	Instruction
					Form	1.2
					Form	1.3
					Instruction
					Instruction
					Form	3.2
					Form	3.3
					Form	3.4
					Form	4.1
					Form	4.2
Countermeasures Injury Compensation Program Request Package	Modified	100	1100	0	Form and Instruction	D
Total burden requested under this ICR:		260	1327	0
To view an IC, click on IC Title