Medical History and Examination

ICR 202301-1405-006

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1405-0068 can be found here:

Forms and Documents

Document Name	Status
Form DS-1622 Medical History and Examination Form and Instruction	Modified
1405-0068 30-day Published.pdf Supplementary Document	2023-01-26
11917_PublishedFR_11-14-2022.pdf Supplementary Document	2023-01-26
Legal Authorities 1405-0068.docx Supplementary Document	2023-01-26
30 day Updated Supporting Statement 1405-0068.docx Supporting Statement A	2023-01-26

IC Document Collections

IC ID	Document Title	Status
14884	Medical History and Examination Form and Instruction	Modified

ICR Details