Information Collection

Report of Medical Examination for Disability Evaluation

IC 28183 under ICR 200712-2900-005 · OMB 2900-0052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0052 can be found here:

Documents and Forms

Document Name Document Type
Form 21-2545 Report of Medical Examination for Disability Evaluation Form
21-2545 Report of Medical Eamination for Disbility Evaluation 21-2545.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Medical Examination for Disability Evaluation	Agency IC Tracking Number:	2900-0052

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.351(d) and (e) 38 CFR 3.326

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-2545	Report of Medical Eamination for Disbility Evaluation	21-2545.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	180,000	180,000
Annual IC Time Burden (Hours)	45,000	45,000
Annual IC Cost Burden (Dollars)	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.