Self Certification Medical Statement

Self - Certification Medical Statement

OMB: 0579-0196

IC ID: 2369

Information Collection (IC) Details

View Information Collection (IC)

Self Certification Medical Statement
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form MRP-5 Self - Certification Medical Statement mrp5-r.pdf No   Paper Only

Natural Resources Agricultural Innovation and Services

 

524 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 524 0 0 -76 0 600
Annual IC Time Burden (Hours) 88 0 0 -12 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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