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

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.