Information Collection Request

Medical Certification for Disability Exceptions

ICR 201702-1615-001 · OMB 1615-0060 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form N-648 Medical Certification for Disability Exceptions Form Modified Available
Supporting Statement Appendix A Form N648 60DayComment Matrix_4JAN2017.docx Supplementary Document Uploaded 2017-02-06 Available
N648-INS-TOC-30 Day-01132017.docx Supplementary Document Uploaded 2017-02-06 Available
N648-FRM-TOC-30 Day-01132017.docx Supplementary Document Uploaded 2017-02-06 Available
FRM N648 Ext 30day Supporting Statement ver4__6FEB2017.doc Supporting Statement A Uploaded 2017-02-06 Available
SORN A File_78 FR 69864_21NOV2013.pdf Supplementary Document Uploaded 2017-02-06 Available
SORN 007 BIS 81FR72069_19OCT2016.pdf Supplementary Document Uploaded 2017-02-06 Repair queued
FRM N648 30DayFRN_6FEB2017.pdf Supplementary Document Uploaded 2017-02-06 Available
PIA CLAIMS4_5SEP2008.pdf Supplementary Document Uploaded 2017-02-06 Available
FRM N648 Ext 60DayFRN_20SEP2016.pdf Supplementary Document Uploaded 2017-02-06 Repair queued
Reference citation 8-8-12.doc Supplementary Document Uploaded 2012-08-08 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
20362 Medical Certification for Disability Exceptions Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2019 36 Months From Approved 03/31/2017
17,302 0 17,302
34,604 0 34,604
912,681 0 847,798





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Medical Certification for Disability Exceptions Form N-648 Medical Certification for Disability Exceptions

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 17,302 17,302 0 0 0 0
Annual Time Burden (Hours) 34,604 34,604 0 0 0 0
Annual Cost Burden (Dollars) 912,681 847,798 0 0 64,883 0


Reginfo record details
  No