OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Pharmacy Billing Requirements

OMB 1215-0194 · DOL/ESA.

OMB 1215-0194

Latest Forms, Documents, and Supporting Material

Document Name
1215-0194 Supporting Stmt 10-28-2009final.doc Supporting Statement A
DOL-ESA-6 (BLBA) and DOL-ESA-49 (EEOICPA) 1215-0194.pdf Supplementary Document
DOL-GOVT-1 (FECA).pdf Supplementary Document
20 CFR 725.701 BLBA regs.pdf (2006 clearance).pdf Supplementary Document
20 CFR 30.701 EEOICPA regs.pdf(2006 clearance).pdf Supplementary Document
20 CFR 10.801 FECA regs.pdf(2006 clearance).pdf Supplementary Document
Pharmacy Billing Requirements Instruction

All Historical Document Collections

200907-1215-004 Approved without change	Extension without change of a currently approved collection	2009-11-17
200701-1215-008 Approved without change	Extension without change of a currently approved collection	2007-01-19
200506-1215-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2005-06-29
200311-1215-002 Approved without change	Revision of a currently approved collection	2003-11-25
200108-1215-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-08-03
200011-1215-003 Approved without change	Extension without change of a currently approved collection	2000-11-28
199712-1215-002 Approved without change	New collection (Request for a new OMB Control Number)	1997-12-17