Information Collection

Report of Physical Examination

IC 200941 under ICR 202011-0420-004 · OMB 0420-0549.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.