Information Collection

Claim, Authorization & Invoice for Prosthetic Items & Services

IC 28432 under ICR 200409-2900-003 · OMB 2900-0188.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0188 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Claim, Authorization & Invoice for Prosthetic Items & Services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	10-2421	No	No
Form	10-426	No	No
Form	10-1394	No	No
Form	10-0103	No	No
Form	10-2520	No	No
Form	10-90	No	No
Form	10-2914	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 697,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	697,200	417,778	-240,422	519,844
Annual IC Time Burden (Hours)	48,522	26,955	-15,512	37,079
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.