Information Collection

Medical History and Examination for Foreign Service

IC 14884 under ICR 201009-1405-003 · OMB 1405-0068.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0068 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-1843P Pre-Employment Medical History and Examination for Foreign Service For Children 12 Years and Over Medical History and Examination for Foreign Service	Form and Instruction
Form DS-1622 Medical History and Examination for Foreign Service for Children 11 Years and Under Medical History and Examination for Foreign Service	Form and Instruction
Form DS-1622P Pre-Employment Medical History and Examination for Foreign Service For Children 11 Years and Under Medical History and Examination for Foreign Service	Form and Instruction
Form DS-1843 Medical History and Examination For Foreign Service For Individuals Age 12 and Older Medical History and Examination for Foreign Service	Form and Instruction
DS-1622 Medical History and Examination for Foreign Service for ds1622.pdf	Form and Instruction
DS-1843P Pre-Employment Medical History and Examination for Forei DS-1843P.pdf	Form and Instruction
DS-1622P Pre-Employment Medical History and Examination for Forei DS-1622P.pdf	Form and Instruction
DS-1843 Medical History and Examination For Foreign Service For DS1843.pdf	Form and Instruction

IC Title:

Medical History and Examination for Foreign Service

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-1622	Yes	No	Fillable Printable
Form and Instruction	DS-1843P	No		Fillable Printable
Form and Instruction	DS-1622P	No		Fillable Printable
Form and Instruction	DS-1843	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,500	266	7,234
Annual IC Time Burden (Hours)	7,500	266	7,234
Annual IC Cost Burden (Dollars)	0	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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].