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CA-27 (Web) Authorization Request form and Certification/Letter of M
Authorization Request Forms/Certification/Letter of Medical Necessity
CA-27 LMNOpioid-UAT with Burden Statement.PNG
CA-27, Authorization Request form and Certification/Letter of Medical Necessity for Opioid Medications
OMB: 1240-0055
OMB.report
DOL/OWCP
OMB 1240-0055
ICR 202404-1240-005
IC 221978
CA-27 (Web) Authorization Request form and Certification/Letter of M
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0055 can be found here:
2024-05-30 - Revision of a currently approved collection
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