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Clinic Examination Form Visual Acuity Impairment Survey

IC 111387 under ICR 198111-0925-002 · OMB 0925-0155.

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CLINIC EXAMINATION FORM VISUAL ACUITY IMPAIRMENT SURVEY
 
No Migrated
 
Voluntary
 

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


    

400 0
   
Individuals or Households
 
   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 400 0 400 0 0 0
Annual IC Time Burden (Hours) 400 0 400 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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