Substance-Related and Addictive Disorders Current Evaluation Form

Individual Specific Medical Evaluation Forms (15)

OMB: 0420-0550

IC ID: 224326

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Substance-Related and Addictive Disorders Current Evaluation Form PC-262-6
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PC-262-6 Substance-Related and Addictive Disorders Current Evaluation Form Substance_Addictive_Disorders_Current_Eval.docx Yes No Fillable Printable

International Affairs and Commerce International Development and Humanitarian Aid

 

373 0
   
Individuals or Households
 
   0 %

  Requested 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 373 0 0 0 0 373
Annual IC Time Burden (Hours) 1,026 0 0 0 0 1,026
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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