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Countermeasures Injury Compensation Program Request Package
Countermeasures Injury Compensation Program (CICP)
OMB: 0915-0334
IC ID: 194529
OMB.report
HHS/HSA
OMB 0915-0334
ICR 202401-0915-002
IC 194529
( )
Documents and Forms
Document Name
Document Type
Form 1
Countermeasures Injury Compensation Program Request Package
Form
Form 1
Countermeasures Injury Compensation Program Request Package
Form
1 CICP Request Form
03132023 - CICP Request Form - OMB 0915-0334.pdf
Form
1A CICP Request Form Instructions
03132023 - CICP Request Form Instructions - OMB 0915-0334.PDF
Form and Instruction
1 CICP Request Form (with Color) in Spanish - Redline
10112023 - (21) CICP Request Form (with color) 2020 in Spanish - REDLINE.docx
Form and Instruction
1 CICP Request Form Instructions in Spanish - Redline
10112023 - (22) CICP Request Form Instructions in Spanish - REDLINE.docx
Form and Instruction
Information Collection (IC) Details
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