Medical Report Forms

MEDICAL REPORT FORMS

OMB: 1215-0103

IC ID: 122147

Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details

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MEDICAL REPORT FORMS
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-16,17,20, No No
Form 28,1090, No No
Form 1302,1303, No No
Form 1304,1306, No No
Form 1308,1316, No No
Form 1331, No No
Form OWCP-5 No No


    

608,500 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 608,500 0 500 0 0 608,000
Annual IC Time Burden (Hours) 151,708 0 0 0 0 151,708
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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