Information Collection

Military Exposure Survey

IC 259032 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Military Exposures Military Exposure Survey	Form and Instruction
Form Military Exposures Military Exposures Care Survey 2023_03_06 Military Exposure Survey	Form and Instruction
Military Exposures Military Exposures Care Survey 2023_03_06 Military Exposures Care Survey 2023_03_06.pdf	Form and Instruction
Military Exposures Military Exposures Care Survey 2023_03_06 Military Exposures Care Survey 2023_03_06.pdf	Form and Instruction
A-11 Fast-Track Clearance Request Template_Military Exposure.pdf A-11 Fast-Track Clearance Request Template_Military Exposure	IC Document
A-11 Fast-Track Clearance Request Template_Military Exposure.pdf A-11 Fast-Track Clearance Request Template_Military Exposure	IC Document

IC Title:

Military Exposure Survey

Agency IC Tracking Number:

Military Exposure Survey 2900-0876

IC Status: Unchanged

Obligation to Respond: Voluntary

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 and Instruction	Military Exposures Care Survey 2023_03_06				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	120,000	120,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A-11 Fast-Track Clearance Request Template_Military Exposure		03/09/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].