Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Additional Documentation and Certification Modified 30 23 0 Form 3
Authorization for Use or Disclosure of Health Information Form Modified 100 200 0 Form and Instruction 2
Benefits Package and Supporting Documentation Modified 30 4 0 Instruction
Instruction
Instruction
Form 4.1
Form 4.2
Form 4.3
Form 4.4
Form 4.5
Form 4.6
Countermeasures Injury Compensation Program Request Package Modified 100 1100 0 Form 1
Form and Instruction 1A
Total burden requested under this ICR: 260 1327 0  
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