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
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
Total burden requested under this ICR: 528000 132000 0  
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