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Certificate of Medical Examination
Certificate of Medical Examination
OMB: 3206-0250
IC ID: 187036
OMB.report
OPM
OMB 3206-0250
ICR 200810-3206-010
IC 187036
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0250 can be found here:
2012-02-02 - Extension without change of a currently approved collection
2012-01-26 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form OF XX
Certificate of Medical Examination
Form and Instruction
OF XX Certificate of Medical Examination
OFXX (FormerlySF78)_2008 07 11_3206NEW.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Certificate of Medical Examination
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
5 CFR 339
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
OF XX
Certificate of Medical Examination
OFXX (FormerlySF78)_2008 07 11_3206NEW.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
OPM/GOVT-10, Employee Medical File System Records
FR Citation:
71 FR 35360
Number of Respondents:
45,000
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
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
45,000
0
45,000
0
0
0
Annual IC Time Burden (Hours)
135,000
0
135,000
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.