Information Collection

Medical Checklist for Transfers (Form P-9A)

IC 242793 under ICR 202012-0970-010 · OMB 0970-0554.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0554 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form P-9A Medical Checklist for Transfers (Form P-9A)	Form
P-9A Medical Checklist for Transfers TAB I - Medical Checklist for Transfers (Form P-9A).docx	Form
P-9A Medical Checklist for Transfers TAB I - Medical Checklist for Transfers (Form P-9A).docx	Form

IC Title:

Medical Checklist for Transfers (Form P-9A)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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	P-9A	Medical Checklist for Transfers	TAB I - Medical Checklist for Transfers (Form P-9A).docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: 09-80-0321 ORR Division of Children's Services Records

FR Citation: 81 FR 46682

Number of Respondents: 206

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,974	5,974
Annual IC Time Burden (Hours)	498	498
Annual IC Cost Burden (Dollars)	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.