Information Collection

Department of Defense Medical Examination Review Board Medical Information Collection Forms

IC 5465 under ICR 200307-0704-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

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: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	DD-2351/DD-2369	No	No
Form	DD-2379	No	No
Form	DD-2492	No	No
Form	DD-2370/DD-2372	No	No
Form	DD-2374/DD-2378	No	No
Form	DD-2381	No	No
Form	DD-2632	No	No
Form	DD-2382	No	No
Form	DD-2489	No	No
Form	DD-2380	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,000	11,000	19,000
Annual IC Time Burden (Hours)	30,000	11,000	19,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.