USM-522A Physician Evaluation Report for USMS Operational Employees

USMS Medical Forms

OMB: 1105-0099

IC ID: 205737

Information Collection (IC) Details

View Information Collection (IC)

USM-522A Physician Evaluation Report for USMS Operational Employees USMS-2013-1-522A
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction USM-522A Physician Evaluation Report for USMS Operational Employees usm522a.pdf Yes No Fillable Printable

Health Health Care Services

OPM/GOVT-10, Employee Medical File System Records  65 FR 24732

300 0
   
Private Sector Businesses or other for-profits
 
   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 300 0 0 0 0 300
Annual IC Time Burden (Hours) 700 0 0 0 0 700
Annual IC Cost Burden (Dollars) 56,700 0 0 0 0 56,700

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

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