Insulin Dependent Diabetic Supplement Documentation Form

Individual Specific Medical Evaluation Forms (15)

OMB: 0420-0550

IC ID: 201719

Information Collection (IC) Details

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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 Dependent Diabetic Supplemental Documentation Form Insulin_Dependent_Diabetic_Supp_Doc.docx Yes No Fillable Printable

International Affairs and Commerce International Development and Humanitarian Aid

Insulin Dependent Diabetic Supplemental Documentation Form   70 FR 1

14 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 14 0 -2 0 0 16
Annual IC Time Burden (Hours) 16 0 -19 0 0 35
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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