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Federal forms, ICRs, and supporting documents

Information Collection

Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form

IC 276038 under ICR 202508-0906-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 117
Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD Score Exception Form		 Form
117. Liver Hepatocellular Carcinoma HCC MELD PELD Initial Exception Score Form_Instructions.docx Instruction
117 Liver Hepatocellular Carcinoma (HCC) Initial MELD/PELD S
117. Liver Hepatocellular Carcinoma (HCC) Initial MELDPELD Score Exception Form_Form.xlsx 		Form

Information Collection (IC) Details

View Information Collection (IC)

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 117 Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 3,309 0 3,309 0 0 0
Annual IC Time Burden (Hours) 1,555 0 1,555 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
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