Information Collection

Health Status Review

IC 917 under ICR 201103-0420-001 · OMB 0420-0510.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0510 can be found here:

Documents and Forms

Document Name Document Type
Form PC-1789 Health Status Review Form and Instruction
PC-1789 Health Status Review HSR_FINAL_03042010_V2.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Status Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-1789	Health Status Review	HSR_FINAL_03042010_V2.pdf		Yes	No	Paper Only

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Volunteer Applicant and Service Records System (PC-17)	FR Citation: 70 FR 1

Number of Respondents: 9,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 93 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,700	9,700
Annual IC Time Burden (Hours)	7,275	7,275
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.