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CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
Authorization Request Forms/Certification/Letter of Medical Necessity
OMB: 1240-0055
IC ID: 221978
OMB.report
DOL/OWCP
OMB 1240-0055
ICR 202404-1240-005
IC 221978
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0055 can be found here:
2024-05-30 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CA-27
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
Form and Instruction
Form CA-27
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
Form and Instruction
CA-27 Authoriization/Request Form and Certification/Letter of Medical Necessity for Opioid Medications
CA 27 LMN Opioids.pdf
Form and Instruction
CA 27 LMN Opioids Instructions.pdf
Instruction
CA-27 (Web) Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
CA-27 LMNOpioid-UAT with Burden Statement.PNG
Form and Instruction
Information Collection (IC) Details
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