DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERS) REPORT OF MEDICAL HISTORY

ICR 198610-0704-009

OMB: 0704-0269

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
0704-0269 198610-0704-009
Historical Active
DOD/DODDEP
DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERS) REPORT OF MEDICAL HISTORY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/12/1987
Retrieve Notice of Action (NOA) 10/14/1986
  Inventory as of this Action Requested Previously Approved
09/30/1989 09/30/1989
60,000 0 0
15,000 0 0
0 0 0

ARMY, AIR FORCE AND NAVY RESERVE OFFICER TRAINING CORPS (ROTC) PROGRAMS AND UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES (USUHA). THIS INFORMATION WILL BE USED TO DETERMINE IF APPLICANT IS MEDICALLY QUALIFIED FOR COMMISSIONING IN THE MILITARY SERVICES.

None
None


No

1
IC Title Form No. Form Name
DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERS) REPORT OF MEDICAL HISTORY DD X218

  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 60,000 0 0 0 60,000 0
Annual Time Burden (Hours) 15,000 0 0 0 15,000 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.
10/14/1986


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