View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

CA-26, Authorization Request Form and Certification/Letter of Medical Necessity for Compounded Drugs
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 10.809 20 CFR 10.310 20 CFR 10.800

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-26 Yes Yes Fillable Fileable Signable
Form CA-26 (Method of Administration Detail) Yes Yes Fillable Fileable Signable
Form CA-26 (Length of Therapy Detail Yes Yes Fillable Fileable Signable
Instruction Yes Yes Fillable Fileable Signable

Workforce Management Labor Rights Management

DOL/GOVT-1  67 FR 16826

15,500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15,500 0 0 0 0 15,500
Annual IC Time Burden (Hours) 7,750 0 0 0 0 7,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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