Information Collection

Form 10-2201E, "Physician Consent Form"

IC 222239 under ICR 202307-1024-001 · OMB 1024-0245.

Documents and Forms

Document Name Document Type
Form Form 10-2201E Form 10-2201E, "Physician Consent Form" Form and Instruction
Form 10-2201E Physician Consent Form 1024-0245 Form 10-2201E Physician Consent Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 10-2201E, "Physician Consent Form"	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	Form 10-2201E	Physician Consent Form	1024-0245 Form 10-2201E Physician Consent Form.pdf		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: OPM/GOVT-5 -Recruiting, Examining, and Placement Records	FR Citation: 79 FR 16834

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-1,700	1,700
Annual IC Time Burden (Hours)	-283	283
Annual IC Cost Burden (Dollars)	-17	17

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.