Information Collection

Application for a Review by the Physical Disability Board of Review

IC 187660 under ICR 201212-0704-006 · OMB 0704-0453.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0453 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 294 Application for a Review by the Physical Disability Board of Review	Form
DD Form 294 Application for a Review by the Physical Disability Boar dd0294 rvd.pdf	Form
F036 SAFCB A.doc Air Force SORN	IC Document
A0015-185 SFMR.doc Army SORN	IC Document
N01850-2.doc Navy SORN	IC Document
NM01000-1.doc Navy SORN	IC Document

IC Title:

Application for a Review by the Physical Disability Board of Review

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	DD Form 294	Application for a Review by the Physical Disability Board of Review	dd0294 rvd.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,800	950	850
Annual IC Time Burden (Hours)	1,350	712	638
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.