Information Collection

Medical Reports

IC 176972 under ICR 199310-3220-005 · OMB 3220-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0038 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	MEDICAL REPORTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	G-260,	No	No
Form	GL-12,	No	No
Form	RL-11B	No	No
Form	RL-11D	No	No
Form	G-3MP,	No	No
Form	G-250,	No	No
Form	G-250A,	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 27,300	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60,950	60,950
Annual IC Time Burden (Hours)	25,187	25,187
Annual IC Cost Burden (Dollars)	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.