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Report of Physical Examination
Report of Physical Examination
OMB: 0420-0549
IC ID: 200941
OMB.report
PEACE
OMB 0420-0549
ICR 202408-0420-001
IC 200941
( )
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
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:
Unchanged
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
Federal Enterprise Architecture Business Reference Module
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 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
5,600
0
0
0
5,600
0
Annual IC Time Burden (Hours)
8,400
0
0
0
8,400
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.