PC 1789 Health History Form 2025

Peace Corps Health History Form

OMB: 0420-0510

IC ID: 277807

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Information Collection (IC) Details

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PC 1789 Health History Form 2025 PC-1789
 
Yes New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-1789 Health History Form PC 1789 Current HHF as of 9-26-2025.pdf Yes Yes Fillable Fileable

International Affairs and Commerce International Development and Humanitarian Aid

PC-17 Volunteer Applicant and Service Records System  79 FR 41599

23,000 0
   
Individuals or Households
 
   99 %

  Requested 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 23,000 0 23,000 0 0 0
Annual IC Time Burden (Hours) 17,250 0 17,250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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