YOUTH CONSERVATION CORPS MEDICAL HISTORY FORM

ICR 198104-1084-002

OMB: 1084-0004

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
167544
Migrated
ICR Details
1084-0004 198104-1084-002
Historical Active 198103-1084-002
DOI/OAPM
YOUTH CONSERVATION CORPS MEDICAL HISTORY FORM
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/16/1981
Approved with change 04/16/1981
Retrieve Notice of Action (NOA) 04/16/1981
  Inventory as of this Action Requested Previously Approved
10/31/1984 10/31/1984 10/31/1984
25,000 0 25,000
25,000 0 25,000
0 0 0

RECORDS PHYSICAL EXAMINATION OF YCC ENROLLEES BY PHYSICIAN TO IDENTIFY PROBLEMS AND DESCRIBE SPECIAL CARE OR TREATMENT REQUIRED. FORM ALSO RECORDS PARENTIAL RELEASE OF GOOD FROM LIABILITY AND CUTTERZATION FOR EMERGENCY MEDICAL TREATMENT.

None
None


No

1
IC Title Form No. Form Name
YOUTH CONSERVATION CORPS MEDICAL HISTORY FORM

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 25,000 25,000 0 0 0 0
Annual Time Burden (Hours) 25,000 25,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/16/1981


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