Report of Physical Examination

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0549 can be found here:

Documents and Forms

Document Name Document Type
Form PC-1790-S Report of Physical Examination Form and Instruction
PC-1790-S Report of Physical Examination Report Physical Exam form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Physical Examination	Agency IC Tracking Number:	PC1790S

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-1790-S	Report of Physical Examination	Report Physical Exam form.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Volunteer Applicant and Service Records	FR Citation: 70 FR 1

Number of Respondents: 5,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,600	1,600	4,000
Annual IC Time Burden (Hours)	8,400	-600	9,000
Annual IC Cost Burden (Dollars)	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.