Information Collection

Report of Medical Examination and Vaccination Record

IC 20305 under ICR 200703-1615-007 · OMB 1615-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0033 can be found here:

Documents and Forms

Document Name Document Type
Form I-693 Report of Medical Examination and Vaccination Record Form and Instruction
I-693 Report of Medical Examination and Vaccination Record I-693 (03-07-07) final.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Medical Examination and Vaccination Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 209 8 CFR 210 8 CFR 245 8 CFR 245a (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	I-693	Report of Medical Examination and Vaccination Record	I-693 (03-07-07) final.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800,000	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	800,000	0	800,000
Annual IC Time Burden (Hours)	2,000,000	800,000	1,200,000
Annual IC Cost Burden (Dollars)	0	-48,648,000	48,648,000

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.