Allergies Questionnaire

Report of Medical History/Examination

OMB: 0990-0324

IC ID: 182396

Information Collection (IC) Details

View Information Collection (IC)

Allergies Questionnaire
 
Yes New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form PHS-7053 Allergies Questionnaire PHS-7053-Allergies Questionnaire No No Printable Only

General Government Central Records & Statistical Mgt

PHS Commissioned Corps Medical Records  63 FR 68596

800 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 800 0 800 0 0 0
Annual IC Time Burden (Hours) 80 0 80 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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