Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CA-26, Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs Unchanged 15500 7750 0 Form CA-26
Form CA-26 (Method of Administration Detail)
Form CA-26 (Length of Therapy Detail
Instruction
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioie Medications Modified 154500 77250 0 Form and Instruction CA-27
Total burden requested under this ICR: 170000 85000 0  
To view an IC, click on IC Title