Purchase Order For And Report Of Contract Dental Care

PURCHASE ORDER FOR AND REPORT OF CONTRACT DENTAL CARE

OMB: 0915-0022

IC ID: 110067

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PURCHASE ORDER FOR AND REPORT OF CONTRACT DENTAL CARE
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HSA-57 No No


    

700 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 35,000 0 35,000 0 0 0
Annual IC Time Burden (Hours) 14,583 0 14,583 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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