Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
DD Form 3040 - Screening Verification Modified 35173 5862 42500 Form and Instruction DD Form 3040
DD Form 3040-1 Medical and Educational Information Modified 84414 42207 306001 Form and Instruction DD Form 3040-1
DD Form 3040-2 - Dental Health Information Modified 101298 25325 2445587 Form and Instruction DD Form 3040-2
DD Form 3040-3 - Patient Care Review Modified 46147 11537 1335610 Form and Instruction DD Form 3040-3
DD Form 3040-4 - Administrative Review Checklist New 35173 5862 42501 Form and Instruction DD Form 3040-4
Total burden requested under this ICR: 302205 90793 4172199  
To view an IC, click on IC Title