Statement Of Applicant And /or Physical Examination Report

STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT

OMB: 2900-0087

IC ID: 174233

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STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 29-4465 No No


    

10,000 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 2,500 0 -7,500 0 0 10,000
Annual IC Time Burden (Hours) 3,250 0 -10,083 0 0 13,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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