Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Health History Form New 23000 17250 0 Form and Instruction 0420-0510
Health History Form (PC 1789) Unchanged 10000 7500 0 Form and Instruction PC-1789
Form and Instruction PC-1789
Total burden requested under this ICR: 33000 24750 0  
To view an IC, click on IC Title