Health Status Review

Peace Corps Volunter Medical Application Health Status Review

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0510 can be found here:

Documents and Forms

Document Name Document Type
Form PC-1789 Health Status Review Form and Instruction
PC-1789 Health Status Review 0420-0510 Health Status Review Brochure.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Health Status Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-1789	Health Status Review	0420-0510 Health Status Review Brochure.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Volunteer Applicant and Service Records System (PC-17)	FR Citation: 70 FR 1

Number of Respondents: 9,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 93 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	9,700	-12,000	21,700
Annual IC Time Burden (Hours)	7,275	-6,000	13,275
Annual IC Cost Burden (Dollars)	0	-564,000	564,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

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