Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Allergies Questionnaire Removed 0 0 0 Form PHS-7053
GYN Questionnaire Removed 0 0 0 Form PHS-7057
Head Injury Questionnaire Removed 0 0 0 Form PHS-7054
Headache Questionnaire Removed 0 0 0 Form PHS-7056
Injury Questionnaire Removed 0 0 0 Form PHS-7055
Qwestry Low Back Questionnaire Removed 0 0 0 Form PHS-7061
Report of Dental Examination Unchanged 1000 1000 0 Form PHS-6355
Report of Medical Examination Removed 0 0 0 Form PHS-6379
Total burden requested under this ICR: 1000 1000 0  
To view an IC, click on IC Title