OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medical Release and Healthcare Source Forms

IC 221994 under ICR 201804-0920-017 · OMB 0920-1162.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Medical Release and Healthcare Source Forms
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Medical Release and Healthcare Source Form - English Attachment 7a. Medical Release and Healthcare Source Forms English 2016 06 10.docx No   Paper Only
Form none Medical Release and Healthcare Source Form - Spanish Attachment 7b. Medical Release and Healthcare Source Forms Spanish.docx No   Paper Only

Health Illness Prevention

 

334 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 334 0 0 0 0 334
Annual IC Time Burden (Hours) 28 0 0 0 0 28
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.