Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Notice to Treat up to 100 Patients Modified 500 20 0 Form and Instruction Waiver Form 100 patients Waiver Form 100 patients
Notice to Treat up to 275 Patients Modified 800 65 0 Form and Instruction Waiver Form 275 patients Waiver Form 275 patients
Notification of Intent Modified 1500 125 0 Instruction
Notification to Prescribe Immediately Modified 50 4 0 Instruction
Practitioner Reporting Form - 8.635 Modified 1350 4050 0 Form and Instruction Practitioner Reporting Form Practitioner Reporting Form
Qualifying Other Practitioner Modified 3176 210 0 Form and Instruction Qualifying Other Pratitioner Qualifying Other Pratitioner
Renewal Request for a Patient Limit Increase - 8.64 Modified 260 130 0 Instruction
Request for Patient Limit - 8.620 Modified 517 259 0 Instruction
Request for a Temporary Patient Increase Patient Increase for an Emergency - 8.655 Modified 10 30 0 Instruction
Total burden requested under this ICR: 8163 4893 0  
To view an IC, click on IC Title