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Medical Certification for Disability Exceptions
Medical Certification for Disability Exceptions
OMB: 1115-0205
IC ID: 12152
OMB.report
DOJ/INS
OMB 1115-0205
ICR 199906-1115-001
IC 12152
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1115-0205 can be found here:
2002-01-09 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medical Certification for Disability Exceptions
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
N-648
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
20,000
0
0
0
0
20,000
Annual IC Time Burden (Hours)
40,000
0
0
0
0
40,000
Annual IC Cost Burden (Dollars)
1,600,000
0
0
0
0
1,600,000
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.