Report of Medical Examination and Vaccination Record

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0033 can be found here:

Documents and Forms

Document Name Document Type
Form I-693 Report of Medical Examination and Vaccination Record Form
I-693 Instructions 4-27-11.pdf Instruction
I-693 Report of Medical Examination and Vaccination Record I-693 Form 4-27-11.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Medical Examination and Vaccination Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 8 CFR 245 8 CFR 245a 8 CFR 209 8 CFR 210 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	I-693	Report of Medical Examination and Vaccination Record	I-693 Form 4-27-11.pdf		Yes	No	Fillable Printable
Instruction			I-693 Instructions 4-27-11.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	800,000	800,000
Annual IC Time Burden (Hours)	2,000,000	2,000,000
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.