PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
HA-66 with Medical Source Information - electronic submission
Modified
196680
49170
0
Other-Internet Screen
HA-66 with Medical Source Information - paper submission
Modified
67320
16830
0
Form and Instruction
HA-66
Request for Medical Evidence From a Doctor
HA-67 with Medical Source Information - electronic submission
Modified
196680
49170
0
Other-Internet Screen
HA-67 with Medical Source Information - paper submission
Modified
67320
16830
0
Form and Instruction
HA-67
Request for Medical Evidence From a Hospital
Total burden requested under this ICR:
528000
132000
0
To view an IC, click on IC Title
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