Medic Data Collection Form

MEDIC DATA COLLECTION FORM

OMB: 0960-0383

IC ID: 166829

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Information Collection (IC) Details

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MEDIC DATA COLLECTION FORM
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-1419 No No


    

54 0
   
State, Local, and Tribal Governments
 
   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 287,729 0 0 0 0 287,729
Annual IC Time Burden (Hours) 23,977 0 0 0 0 23,977
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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