Medical History and Examination

ICR 202307-1405-001

OMB: 1405-0068

Federal Form Document

⚠️ Notice: This information collection may be outdated.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

2023-12-17 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Form DS-1622 Medical History and Examination Form and Instruction	Modified
Form DS-1622 Medical History and Examination Form and Instruction	Modified
Non - Substantive change DS-1843.docx Justification for No Material/Nonsubstantive Change	2023-07-10
Non - Substantive change DS-1843.docx Justification for No Material/Nonsubstantive Change	2023-07-10
1405-0068 30-day Published.pdf Supplementary Document	2023-01-26
1405-0068 30-day Published.pdf Supplementary Document	2023-01-26
11917_PublishedFR_11-14-2022.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
Legal Authorities 1405-0068.docx Supplementary Document	2023-01-26
30 day Supporting Statement 1405-0068.docx Supporting Statement A	2023-04-03
30 day Supporting Statement 1405-0068.docx Supporting Statement A	2023-04-03

IC Document Collections

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

ICR Details

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