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Supplemental Doctor's Statement

IC 157427 under ICR 198703-3220-004 · OMB 3220-0045.

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SUPPLEMENTAL DOCTOR'S STATEMENT
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SI-7 No No
Form ID-7H No No


    

50,050 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 50,050 0 0 0 0 50,050
Annual IC Time Burden (Hours) 4,171 0 0 0 0 4,171
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.