Information Collection Request
Countermeasures Injury Compensation Program (CICP)
ICR 202303-0915-005 · OMB 0915-0334 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0334 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 3 Additional Documentation and Certification |
Form | Modified | Repair queued |
| Form 2 Authorization for Use or Disclosure of Health Information Form |
Form and Instruction | Modified | Repair queued |
| Form 1 Countermeasures Injury Compensation Program Request Package |
Form | Modified | Repair queued |
 03162023 - Supporting Statement A - CICP 30-Day Extension Request OMB 0915-0334.docx |
Supporting Statement A | Uploaded 2023-03-24 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208418 |  Benefits Package and Supporting Documentation |
Instruction | Modified | |
| 208417 | Additional Documentation and Certification |
Form | Modified | |
| 208416 | Authorization for Use or Disclosure of Health Information Form |
Form and Instruction | Modified | |
| 194529 | Countermeasures Injury Compensation Program Request Package |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/HSA |
| OMB Control No | 0915-0334 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202110-0915-001 |
| Agency Tracking No | 20201 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |