Certificates of Medical Examination

Certificate of Medical Examination

OMB: 0583-0167

IC ID: 218023

Information Collection (IC) Details

View Information Collection (IC)

Certificates of Medical Examination
 
No Modified
 
Required to Obtain or Retain Benefits
 
5 CFR 339

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 4630-7 Confidential Medical Documentation FSIS 4630-7 CONFIDENTIAL MEDICAL DOCUMENTATION _v8RE508 (004) - Copy.pdf Yes No Printable Only
Form 4306-5 Medical Documentation for Employees Reasonable Accommodation Request FSIS 4306-5 MEDICAL DOCUMENTATION FOR EMPLOYEES REASONABLE ACCOMMODATION REQUEST _v8RE508_BAK (002).pdf Yes No Printable Only
Form and Instruction 4339-1 Certificate of Medical Examination (with Report of Medical History) FSIS 4339-1 Certificate of Medical Examination (with Report of Medical History) 05202020.pdf Yes No Fillable Printable

Health Consumer Health and Safety

Employee Medical File System (OPM/Govt-10)  75 FR 35099

800 0
   
Individuals or Households
 
   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 800 0 0 0 0 800
Annual IC Time Burden (Hours) 809 0 0 0 0 809
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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