Medical Examination for Immigrant or Refugee Applicant

ICR 200601-1405-003

OMB: 1405-0113

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
38745 Migrated
ICR Details
1405-0113 200601-1405-003
Historical Active 200504-1405-004
STATE/AFA
Medical Examination for Immigrant or Refugee Applicant
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/24/2006
Retrieve Notice of Action (NOA) 01/24/2006
  Inventory as of this Action Requested Previously Approved
05/31/2007 05/31/2007 05/31/2007
630,000 0 630,000
630,000 0 630,000
0 0 63,000,000

Form DS-2053, DS-3024, DS-3025 and DS-3026 are completed by panel physicians for refugees and aliens seeking immigrant visas to the U.S. The collection records medical information necessary to determine whether refugees or immigrant visa applicants have medical conditions affecting the public health and requiring treatment.

None
None


No

1
IC Title Form No. Form Name
Medical Examination for Immigrant or Refugee Applicant DS-2053, DS-3024, DS-3025, DS-3026

  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 630,000 630,000 0 0 0 0
Annual Time Burden (Hours) 630,000 630,000 0 0 0 0
Annual Cost Burden (Dollars) 0 63,000,000 0 0 -63,000,000 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.
01/24/2006


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