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Statement Of Applicant And /or Physical Examination Report

IC 146966 under ICR 198706-2900-013 · OMB 2900-0087.

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STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 29-4465 No No


    

1,615 0
   
Individuals or Households
 
   0 %

  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 1,615 0 0 0 0 1,615
Annual IC Time Burden (Hours) 2,100 0 0 0 0 2,100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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