Claim, Authorization and Invoice for Prosthetic Items and Services

Claim, Authorization and Invoice for Prosthetic Items and Services

OMB: 2900-0188

IC ID: 28431

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

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Claim, Authorization and Invoice for Prosthetic Items and Services
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 10-90 No No
Form 10-2421 No No
Form 10-0103 No No
Form 10-2914 No No
Form 10-1394 No No
Form 10-426 No No
Form 10-2520 No No


    

519,844 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 519,844 0 0 0 0 519,844
Annual IC Time Burden (Hours) 37,079 0 0 0 0 37,079
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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