Information Collection

Health Status Review

IC 917 under ICR 201201-0420-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

Health Status Review

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	Program Change Due to Agency Discretion	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

table that charts IC Documents
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.