Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
HA-66 with Medical Source Information - electronic submission Modified 279576 69894 0 Other-Internet Screen
HA-66 with Medical Source Information - paper submission Modified 150546 37637 0 Form and Instruction HA-66
HA-67 with Medical Source Information - electronic submission Modified 112442 28111 0 Other-Internet Screen
HA-67 with Medical Source Information - paper submission Modified 60544 15136 0 Form and Instruction HA-67
Total burden requested under this ICR: 603108 150778 0  
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