Report of Medical Examination

Peace Corps Volunter Medical Application and Health Status Review

OMB: 0420-0510

IC ID: 183919

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Report of Medical Examination
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-1790S Report of Medical Examination Physical Exam 090309.pdf Yes No Paper Only

International Affairs and Commerce International Development and Humanitarian Aid

Volunteer Applicant and Service Records System (PC-17)  70 FR 1

5,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,000 0 -6,000 5,000 0 6,000
Annual IC Time Burden (Hours) 3,750 0 -6,525 7,275 0 3,000
Annual IC Cost Burden (Dollars) 260,000 0 -52,000 0 0 312,000

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

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