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Medical History And Examination For Foreign Service
MEDICAL HISTORY AND EXAMINATION FOR FOREIGN SERVICE
OMB: 1405-0068
IC ID: 169173
OMB.report
STATE/AFA
OMB 1405-0068
ICR 198904-1405-006
IC 169173
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0068 can be found here:
2023-12-17 - No material or nonsubstantive change to a currently approved collection
2023-07-10 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MEDICAL HISTORY AND EXAMINATION FOR FOREIGN SERVICE
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FORM 264
No
No
Form
DS-1622
No
No
Form
OPTIONAL
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,677
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
3,677
0
0
0
0
3,677
Annual IC Time Burden (Hours)
919
0
0
0
0
919
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.