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Federal forms, ICRs, and supporting documents

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Durable Medical Equipment and Other Devices form

IC 223812 under ICR 202408-0420-003 · OMB 0420-0559.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Durable Medical Equipment and Other Devices form
 
Yes Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-262-3 Durable Medical Equipment Form DME Form - OMB changes.docx Yes Yes Fillable Fileable

International Affairs and Commerce International Development and Humanitarian Aid

 

400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400 0 0 0 400 0
Annual IC Time Burden (Hours) 100 0 0 0 100 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Justification for changes Justification for revised DME_Final 1_25_16.docx 02/07/2017
Changes to form DME Form - OMB changes.docx 02/14/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.