Alcohol/Substance Abuse Current Evaluation

Individual Specific Medical Evaluation Forms (16)

OMB: 0420-0550

IC ID: 201710

Information Collection (IC) Details

View Information Collection (IC)

Alcohol/Substance Abuse Current Evaluation
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-262-6 Alcohol/Substance Abuse Current Evaluation Form Alcohol_Substance Abuse_Eval.pdf Yes Yes Fillable Printable

International Affairs and Commerce International Development and Humanitarian Aid

Volunteer Applicant and Service Records  70 FR 1

200 0
   
Individuals or Households
 
   99 %

  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 200 0 200 0 0 0
Annual IC Time Burden (Hours) 750 0 750 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

© 2024 OMB.report | Privacy Policy