Request for Examination

Documents and Forms

Document Name Document Type
Form 680-3A-E Request for Examination Form
680-3A-E Request for Examination 680-3A-E New Draft.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	680-3A-E	Request for Examination	680-3A-E New Draft.doc		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: A0601-270 USMEPCOM DoD	FR Citation: 70 FR 9284

Number of Respondents: 850,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	850,000	850,000
Annual IC Time Burden (Hours)	141,950	141,950
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.