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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Medical Source Statement of Ability To Do Work-Related Activities (Physical)
Unchanged
150000
37500
0
Form
HA-1151
Medical Source Statement of Ability to Do Work-Related Activities (Physical)
Medical Source Statement of Ability to Do Work-Related Activities (Mental)
Modified
150000
37500
0
Form
HA-1152
Medical Source Statement of Ability to Do Work-Related Activity (Mental)
Total burden requested under this ICR:
300000
75000
0
To view an IC, click on IC Title
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