Category I , CE a) Medical Evidence from CE Providers (Paper Forms; subset of "CE Forms Samples" category)

Disability Case Development Information Collections

OMB: 0960-0555

IC ID: 9480

Documents and Forms

Document Name Document Type
Category I - CE a) Credentialing - Revised.pdf Other-Samples of DDS CE Forms
Claimant Request with Cardiac Questionnaire.pdf Other-Claimant Request with Cardiac Questionnaire
Claimant Request with Fatigue Questionnaire.pdf Other-Claimant Request with Fatigue Questionnaire
Claimant Request with Headache Questionnaire.pdf Other-Claimant Request with Headache Questionnaire
Claimant Request with Pain Questionnaire.pdf Other-Claimant Request with Pain Questionnaire
Claimant Request with Seizure Questionnaire.pdf Other-Claimant Request with Seizure Questionnaire
Claimant Request with Vision Questionnaire.pdf Other-Claimant Request with Vision Questionnaire
Category I - CE a) Paper Submissions Samples - Current.pdf Category I - CE a) Paper Submissions Samples - Current IC Document