Report of Physical Examination

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0549 can be found here:

Documents and Forms

Document Name Document Type
Form PC-1790S Report of Physical Examination Form and Instruction
PC-1790S Physical Examination Form PC-1790-S_Physical_Exam_2020.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Physical Examination	Agency IC Tracking Number:	PC1790S

Is this a Common Form? Yes		IC Status: Modified

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-1790S	Physical Examination Form	PC-1790-S_Physical_Exam_2020.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Volunteer Applicant and Service Records	FR Citation: 70 FR 1

Number of Respondents: 10,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10,200	4,600	5,600
Annual IC Time Burden (Hours)	22,950	14,550	8,400
Annual IC Cost Burden (Dollars)	0	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.