Information Collection

Report of Medical Examination for Disability Evaluation

IC 28183 under ICR 200712-2900-005 · OMB 2900-0052.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0052 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21-2545 Report of Medical Eamination for Disbility Evaluation Report of Medical Examination for Disability Evaluation	Form
21-2545 Report of Medical Eamination for Disbility Evaluation 21-2545.pdf	Form

IC Title:

Report of Medical Examination for Disability Evaluation

Agency IC Tracking Number:

2900-0052

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 3.351(d) and (e) 38 CFR 3.326

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	21-2545				No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180,000

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	Previously Approved
Annual Number of Responses for this IC	180,000	180,000
Annual IC Time Burden (Hours)	45,000	45,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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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