Certificate of Medical Examination

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0250 can be found here:

Documents and Forms

Document Name Document Type
Form OF XX Certificate of Medical Examination Form and Instruction
OF XX Certificate of Medical Examination OFXX (FormerlySF78)_2008 07 11_3206NEW.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certificate of Medical Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 339

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OF XX	Certificate of Medical Examination	OFXX (FormerlySF78)_2008 07 11_3206NEW.pdf		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: OPM/GOVT-10, Employee Medical File System Records	FR Citation: 71 FR 35360

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	135,000	135,000
Annual IC Cost Burden (Dollars)	0	0

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.