Insulin Dependent Diabetic Supplement Documentation Form

Individual Specific Medical Evaluation Forms (16)

OMB: 0420-0550

IC ID: 201719

Information Collection (IC) Details

View Information Collection (IC)

Insulin Dependent Diabetic Supplement Documentation Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-262-10 Insulin Depended Diabetic Supplemental Form Insulin Dependent Diabetic Management Plan.pdf Yes Yes Fillable Printable

International Affairs and Commerce International Development and Humanitarian Aid

Volunteer Applicant and Service Records  70 FR 1

16 0
   
Individuals or Households
 
   99 %

  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 16 0 0 0 0 16
Annual IC Time Burden (Hours) 35 0 0 0 0 35
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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