Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Documentation and Certification Unchanged 30 23 0 Form F
Authorization for Use or Disclosure of Health Information Form Modified 100 200 0 Instruction
Form E
Instruction
Form E - Spanish
Benefits Package and Supporting Documentation Unchanged 30 4 0 Instruction
Instruction
Instruction
Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Form and Instruction 5
Form and Instruction 6
Countermeasures Injury Compensation Program Request Package Modified 100 1100 0 Form and Instruction D
Instruction
Form D - Spanish
Total burden requested under this ICR: 260 1327 0  
To view an IC, click on IC Title