Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
EE-22 (General Medical Authorization Request) Modified 3000 500 0 Form and Instruction EE-22
EE-24 (Durable Medical Equipment Authorization) Modified 20000 3333 0 Form and Instruction EE-24
EE-26 (Rehabilitative Therapies Authorization Request) Modified 2500 417 0 Form and Instruction EE-26
EE-28 (Transportation Authorization Request) Modified 2500 417 0 Form and Instruction EE-28
EE-30 (Transplant Authorization Request) Modified 20 3 0 Form and Instruction EE-30
EE-32 (Home Health Care Authorization Request) Modified 70000 11667 0 Form and Instruction EE-32
Total burden requested under this ICR: 98020 16337 0  
To view an IC, click on IC Title