Application for Authorization to Issue Health Care Certificates

Application for Authorization to Issue Health Care Certificates

OMB: 1615-0086

IC ID: 20414

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Document Type
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Information Collection (IC) Details

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Application for Authorization to Issue Health Care Certificates
 
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 I-905 No No


    

10 0
   
Private Sector Not-for-profit institutions
 
   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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 40 0 0 0 0 40
Annual IC Cost Burden (Dollars) 2,000 0 0 -1,000 0 3,000

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