Information Collection

Department of Defense Medical Examination Review Board Medical Information Collection Forms

IC 5463 under ICR 199705-0704-002 · OMB 0704-0396.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0396 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	Department of Defense Medical Examination Review Board Medical Information Collection Forms	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	2489	No	No
Form	2378-2383	No	No
Form	2480	No	No
Form	2370	No	No
Form	2372	No	No
Form	2374	No	No
Form	DD-2351	No	No
Form	2492	No	No
Form	2375	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19,000	19,000
Annual IC Time Burden (Hours)	19,000	19,000
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.