Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EE-22 (General Medical Authorization Request) Unchanged 15700 2617 0 Form and Instruction EE-22
EE-24 (Durable Medical Equipment Authorization) Unchanged 1700 283 0 Form and Instruction EE-24
EE-26 (Rehabilitative Therapies Authorization Request) Unchanged 400 67 0 Form and Instruction EE-26
EE-28 (Transportation Authorization Request) Unchanged 2256 376 0 Form and Instruction EE-28
EE-30 (Transplant Authorization Request) Unchanged 10 2 0 Form and Instruction EE-30
EE-32 (Home Health Care Authorization Request) Modified 46704 7784 0 Form and Instruction EE-32
Total burden requested under this ICR: 66770 11129 0  
To view an IC, click on IC Title