Information Collection

NSF 1425-A, Polar Dental Examination - Antarctica

IC 182054 under ICR 201101-3145-003 · OMB 3145-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3145-0177 can be found here:

Documents and Forms

Document Name Document Type
Form 1425-A NSF 1425-A, Polar Dental Examination - Antarctica Form and Instruction
1425-A Polar Dental Examination 1425-A, Polar Dental Exam.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NSF 1425-A, Polar Dental Examination - Antarctica	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 675

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1425-A	Polar Dental Examination	1425-A, Polar Dental Exam.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: NSF-19, Medical Examination Records for Service in the Polar Regions	FR Citation: 62 FR 59895

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	-500	3,500
Annual IC Time Burden (Hours)	6,000	-1,000	7,000
Annual IC Cost Burden (Dollars)	0	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.