Health Status Review/Report of Medical Exam

ICR 200011-0420-001

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
916 Migrated
ICR Details
0420-0510 200011-0420-001
Historical Active 199708-0420-001
PEACE
Health Status Review/Report of Medical Exam
Extension without change of a currently approved collection   No
Regular
Approved without change 02/22/2001
Retrieve Notice of Action (NOA) 11/01/2000
  Inventory as of this Action Requested Previously Approved
03/31/2004 03/31/2004 02/28/2001
12,500 0 1
4,625 0 1,625
16,000 0 616,000

All appointments for service in the Peace Corps must undergo a physical examination prior to service. The results of these examinations are used to ensure that the applicants will be able to serve in the Peace Corps without jeopardizing their health.

None
None


No

1
IC Title Form No. Form Name
Health Status Review/Report of Medical Exam PC-1789, 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 12,500 1 0 12,499 0 0
Annual Time Burden (Hours) 4,625 1,625 0 3,000 0 0
Annual Cost Burden (Dollars) 16,000 616,000 0 0 -600,000 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.
11/01/2000


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