PEACE CORPS MEDICAL HISTORY AND EXAMINATION FORMS

ICR 198804-0420-001

OMB: 0420-0510

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
98925 Migrated
ICR Details
0420-0510 198804-0420-001
Historical Active
PEACE
PEACE CORPS MEDICAL HISTORY AND EXAMINATION FORMS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/13/1988
Retrieve Notice of Action (NOA) 04/12/1988
  Inventory as of this Action Requested Previously Approved
05/31/1991 05/31/1991
15,540 0 0
5,828 0 0
0 0 0

ALL APPLICANTS FOR SERVIC IN THE PEACE CORPS MUST UNDERGO A PHYSICAL EXAMINATION PRIOR TO SERVIC THE RESULTS OF THESE EXAMINATIONS ARE USED TO ENSURE THAT THE APPLICAN WILL BE ABLE TO SERVE IN PEACE CORPS WITHOUT JEOPARDIZING THEIR HEALTH

None
None


No

1
IC Title Form No. Form Name
PEACE CORPS MEDICAL HISTORY AND EXAMINATION FORMS RMH PC-1789, RME PC-1790

  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 15,540 0 0 15,540 0 0
Annual Time Burden (Hours) 5,828 0 0 5,828 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
04/12/1988


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