Asthma Evaluation Form

Individual Specific Medical Evaluation Forms (15)

Documents and Forms

Document Name Document Type
Form PC-262-2 Asthma Evaluation Form Form and Instruction
PC-262-2 Asthma Evaluation Form Asthma_Eval.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Asthma Evaluation Form	Agency IC Tracking Number:	PC-262-2

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-262-2	Asthma Evaluation Form	Asthma_Eval.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Asthma Evaluation Form	FR Citation: 70 FR 1

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	350	350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.