OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medical History and Examination

IC 14884 under ICR 202603-1405-001 · OMB 1405-0068.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Medical History and Examination
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DS-1622 Medical History and Examination for Children age 11 and younger DS-1622 12-15-2023.pdf No   Fillable Printable
Form and Instruction DS-1843 Medical History and Examination for Children age 12 and older DS-1843 12-15-2023.pdf No   Fillable Printable

Health Health Care Services

 

2,561 0
   
Individuals or Households
 
   100 %

  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 2,561 0 0 0 0 2,561
Annual IC Time Burden (Hours) 2,561 0 0 0 0 2,561
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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