Information Collection

Application for a Review by the Physical Disability Board of Review

IC 187660 under ICR 202102-0704-014 · OMB 0704-0453.

Documents and Forms

Document Name Document Type
Form DD Form 294 Application for a Review by the Physical Disability Board of Review Form
DD Form 294 Application for a Review by the Physical Disability Boar DD 294 Draft 6.23.2021.pdf Form
DD Form 294 Application for a Review by the Physical Disability Boar DD 294 Draft 6.23.2021.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for a Review by the Physical Disability Board of Review	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 294	Application for a Review by the Physical Disability Board of Review	DD 294 Draft 6.23.2021.pdf		Yes	No	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	240	-1,560	1,800
Annual IC Time Burden (Hours)	180	-1,170	1,350
Annual IC Cost Burden (Dollars)	4,860	4,860	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.