OMB control number

Special Agent Medical (Preplacement/Incumbent)

OMB 1140-0056 · DOJ/ATF.

OMB 1140-0056

The Special Agent Medical (Preplacement/Incumbent) Form - ATF Form 2300.10 is used to collect specific personally identifiable information (PII), including the name, address, telephone, social security number and certain medical data. The collected medical data is used to determine if a candidate is medically qualified for and can be hired to serve as a criminal investigator (special agent) or an explosives enforcement officer.

The latest form for Special Agent Medical (Preplacement/Incumbent) expires 2026-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form ATF F 2300.10 Special Agent Medical (Preplacement/Incumbent) Form and Instruction
5 CFR 339.301 Authority to Require an Examination 1.1.2019.pdf Supplementary Document
1140-0056 Supporting Statement A (2023).docx Supporting Statement A
Special Agent Medical (Preplacement/Incumbent) Form and Instruction

All Historical Document Collections

202306-1140-007 Approved without change	Revision of a currently approved collection	2023-07-31
202004-1140-005 Approved without change	Revision of a currently approved collection	2020-04-23
201702-1140-002 Approved without change	Revision of a currently approved collection	2017-02-24
201312-1140-001 Approved without change	Reinstatement with change of a previously approved collection	2013-12-03
201009-1140-003 Approved without change	Extension without change of a currently approved collection	2010-09-22
200706-1140-004 Approved without change	Extension without change of a currently approved collection	2007-07-12
200405-1140-004 Approved without change	Extension without change of a currently approved collection	2004-05-28
200301-1140-070 Approved without change	New collection (Request for a new OMB Control Number)	2003-01-24