Information Collection

Electronic Medical Examination for Visa Applicant

IC 254784 under ICR 202207-1405-005 · OMB 1405-0230.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0230 can be found here:

Documents and Forms

Document Name Document Type
Form DS-7794 Electronic Medical Examination for Visa Applicant Form and Instruction
DS-7794 Panel Physician Report on Medical Examination and Vaccin (005) Tab 4 -- DS-7794 Screen Shots.pdf Form and Instruction
DS-7794 Panel Physician Report on Medical Examination and Vaccin (005) Tab 4 -- DS-7794 Screen Shots.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Electronic Medical Examination for Visa Applicant	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	DS-7794	Panel Physician Report on Medical Examination and Vaccination Record	(005) Tab 4 -- DS-7794 Screen Shots.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 580,330	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	580,330	580,330
Annual IC Time Burden (Hours)	0	0
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.