Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
DD Form X678 Series New 17943 4617 177030 Form and Instruction DD X678 TEST Screening Verification
Form and Instruction DD X678-1 TEST Medical and Educational Information
Form and Instruction DD X678-2 TEST Dental Health Information
Form and Instruction DD X678-3 TEST Patient Care Review
Form and Instruction DD X678-4 TEST Administrative Review Checklist
Total burden requested under this ICR: 17943 4617 177030  
To view an IC, click on IC Title