PEACE CORPS MEDICAL HISTORY AND EXAMINATION FORMS

ICR 199106-0420-001

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
98926 Migrated
ICR Details
0420-0510 199106-0420-001
Historical Active 198804-0420-001
PEACE
PEACE CORPS MEDICAL HISTORY AND EXAMINATION FORMS
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/02/1991
Retrieve Notice of Action (NOA) 06/17/1991
  Inventory as of this Action Requested Previously Approved
07/31/1994 07/31/1994
15,540 0 0
5,828 0 0
0 0 0

ALL APPOINTMENTS FOR SERVICE IN THE PEACE CORPS MUST UNDERGO A PHYSICA EXAMINATION PRIOR TO SERVICES. THE RESULTS OF THESE EXAMINATIONS ARE USED TO ENSURE THAT THE APPLICANTS WILL BE ABLE TO SERVE IN PEACE CORP 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.
06/17/1991


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