Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Application and Statement (Contractor Applicant)- SSA-3192 Modified 195 98 0 Form and Instruction SSA-3192 (Contractor Applicant)
Other-Revised PA Statement
SSA-3193 (Contractor Applicant) Modified 195 49 0 Form and Instruction SSA-3193
Other-Revised PA Statement
SSA-3193 (Physician) Modified 233 350 0 Form and Instruction SSA-3193 (Physician)
Other-Revised PA Statement
Total burden requested under this ICR: 623 497 0  
To view an IC, click on IC Title