Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Notice to Treat up to 100 Patients Modified 600 24 0 Form and Instruction NOI Physicians 30 and 100 Waiver NOI Physicians 30 and 100 Waiver
Notice to Treat up to 275 Patients Modified 960 78 0 Form and Instruction NOI 275 All Practitioners Waiver NOI 275 All Practitioners Waiver
Notification of Intent Modified 1800 149 0 Instruction
Notification to Prescribe Immediately Modified 60 5 0 Instruction
Practitioner Reporting Form Modified 1620 4860 0 Form and Instruction All Practitioner Reporting Form All Practitioner Reporting Form
Qualifying Other Practitioner Modified 3811 252 0 Form and Instruction NOI Qualifying Other Practitioner NP and PA 30 and NOI Qualifying Other Practitioner NP and PA 30 and 100
Renewal Request for a Patient Limit Increase - 8.64 Modified 936 468 0 Instruction
Request for Patient Limit - 8.620 Modified 1860 930 0 Instruction
Request for a Temporary Patient Increase Patient Increase for an Emergency - 8.655 Modified 36 108 0 Instruction
Total burden requested under this ICR: 11683 6874 0  
To view an IC, click on IC Title