Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/xxxx
Appendix C
Appeal to Eligibility Denial
This document represents the burden that will result from the respondents appealing the denial of enrollment.
Public reporting burden of
this collection of information is estimated to average 30minutes per
response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to
CDC/ATSDR Information Collection Review Office, 1600 Clifton Road
NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | rmf2 |
File Modified | 0000-00-00 |
File Created | 2021-01-29 |