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 Modified 500 250 0 Form CA-26
Form CA-26 (Method of Administration Detail)
Form CA-26 (Length of Therapy Detail
Instruction
Form CA-26
Form CA-27
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications Modified 45100 22550 0 Form and Instruction CA-27
Instruction
Form and Instruction CA-27 (Web)
Total burden requested under this ICR: 45600 22800 0  
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