Department of Defense Medical Examination Review Board Medical Information Collection Forms

ICR 200307-0704-001

OMB: 0704-0396

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0704-0396 200307-0704-001
Historical Active 200005-0704-007
DOD/DODDEP
Department of Defense Medical Examination Review Board Medical Information Collection Forms
Extension without change of a currently approved collection   No
Regular
Approved without change 09/12/2003
Retrieve Notice of Action (NOA) 07/08/2003
DoD is encouraged to consider making the many DoD medical information forms available in fillable, printable format for military applicants to service academies, ROTC, or Uniformed Services University of Health Sciences in keeping with the spirit of the Governmen Paperwork Elimination Act.
  Inventory as of this Action Requested Previously Approved
09/30/2006 09/30/2006 09/30/2003
30,000 0 19,000
30,000 0 19,000
0 0 0

Information will be used to access a medical qualification/ disqualification status for individuals applying to one or more United States Military Service Academies, Reserve Officer Training Corps (ROTC) College Scholarship Programs, or the Uniformed Services University of Health Sciences (USUHS). Respondents are individuals interested in serving in the military and attending one of the military academies, ROTC College Scholarship Programs, or USUHS.

None
None


No

1
IC Title Form No. Form Name
Department of Defense Medical Examination Review Board Medical Information Collection Forms DD-2351/DD-2369, DD-2370/DD-2372, DD-2374/DD-2378, DD-2379, DD-2380, DD-2381, DD-2382, DD-2489, DD-2492, DD-2632

  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 30,000 19,000 0 0 11,000 0
Annual Time Burden (Hours) 30,000 19,000 0 0 11,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
07/08/2003


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