Request To Firm For Estimate Of Cost For Purchase Or Repair Of Prosthetic Appliances

REQUEST TO FIRM FOR ESTIMATE OF COST FOR PURCHASE OR REPAIR OF PROSTHETIC APPLIANCES

OMB: 2900-0338

IC ID: 174661

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REQUEST TO FIRM FOR ESTIMATE OF COST FOR PURCHASE OR REPAIR OF PROSTHETIC APPLIANCES
 
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 FL 10-90 No No


    

20,000 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 22,500 0 2,500 0 0 20,000
Annual IC Time Burden (Hours) 1,860 0 260 0 0 1,600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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