Information Collection

Application for a Review by the Physical Disability Board of Review

IC 187660 under ICR 200812-0704-004 · OMB 0704-0453.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0453 can be found here:

Documents and Forms

Document Name Document Type
Form DD Form 294 Application for a Review by the Physical Disability Board of Review Form
DD Form 294 Application for a Review by the Physical Disability Boar Draft DD Form 294.pdf Form
OMB Request (Emergency).pdf OMB Request (Emergency) IC Document
STATEMENT OF DETERMINATION.doc Statement of Determination IC Document
F036 SAFCB A.doc Air Force SORN IC Document
A0015-185 SFMR.doc Army SORN IC Document
N01850-2.doc Navy SORN IC Document
NM01000-1.doc Navy SORN IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for a Review by the Physical Disability Board of Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 294	Application for a Review by the Physical Disability Board of Review	Draft DD Form 294.pdf		No		Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	1,350	1,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Request (Emergency)	OMB Request (Emergency).pdf	12/23/2008
Statement of Determination	STATEMENT OF DETERMINATION.doc	12/23/2008
Air Force SORN	F036 SAFCB A.doc	12/23/2008
Army SORN	A0015-185 SFMR.doc	12/23/2008
Navy SORN	N01850-2.doc	12/23/2008
Navy SORN	NM01000-1.doc	12/23/2008

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