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Smallpox Vaccine Injury Compensation Program Certification form

IC 181667 under ICR 200708-0915-003 · OMB 0915-0282.

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Smallpox Vaccine Injury Compensation Program Certification form
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 102

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form certification certification 0282 certification.doc Yes No Fillable Printable
Instruction 0282 certification instructions.doc Yes No Fillable Printable

Health Health Care Services

Smallpox Vaccine Injury Compensation Program, HHS/HRSA/OSP  68 FR 62301

25 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 25 0 0 25 0 0
Annual IC Time Burden (Hours) 25 0 0 25 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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