Information Collection Request
Countermeasures Injury Compensation Program (CICP)
ICR 202401-0915-002 · OMB 0915-0334 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0334 can be found here:
Forms and Documents
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 208418 |  Benefits Package and Supporting Documentation |
Instruction | Modified | |
| 208417 | Additional Documentation and Certification |
Form | Modified | |
| 208417 | Additional Documentation and Certification |
Form | Modified | |
| 208416 | Authorization for Use or Disclosure of Health Information Form |
Form and Instruction | Modified | |
| 208416 | Authorization for Use or Disclosure of Health Information Form |
Form and Instruction | Modified | |
| 194529 | Countermeasures Injury Compensation Program Request Package |
Form | Modified | |
| 194529 | Countermeasures Injury Compensation Program Request Package |
Form | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/HSA |
| OMB Control No | 0915-0334 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202303-0915-005 |
| Agency Tracking No | 20201 |
| Date Submitted to OIRA | 2024-01-09 |
| Requested Expiration Date | 1969-12-31 |