Supplemental Medical History Questionnaire (PFPA Form 6040)

PFPA Recruitment, Medical, and Fitness Forms

OMB: 0704-0588

IC ID: 236253

Information Collection (IC) Details

View Information Collection (IC)

Supplemental Medical History Questionnaire (PFPA Form 6040)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction PFPA Form 6040 Supplemental Medical History Questionnaire PFPA 6040 Supplemetal History Questionnaire2.PDF Yes Yes Fillable Fileable Signable

Defense and National Security Operational Defense

 

240 0
   
Individuals or Households
 
   75 %

  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 240 0 240 0 0 0
Annual IC Time Burden (Hours) 80 0 80 0 0 0
Annual IC Cost Burden (Dollars) 1,920 0 1,920 0 0 0

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