Information Collection

Application for a Review by the Physical Disability Board of Review

IC 187660 under ICR 201003-0704-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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-DD294.pdf	Form
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

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	DD Form 294	Application for a Review by the Physical Disability Board of Review	Draft-DD294.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 850

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	850	-950	1,800
Annual IC Time Burden (Hours)	638	-712	1,350
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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