Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Submission Modified 70 70 0 Form Form #4
Data Use Agreement Modified 70 4 0 Form and Instruction Form #2
Eligibility Form Modified 70 4 0 Form Form #1
Medical Office Information Form Modified 2450 204 0 Form Form #3
Total burden requested under this ICR: 2660 282 0  
To view an IC, click on IC Title