Information Collection

Professional Qualifications Medical/Peer Reviewers

IC 5569 under ICR 202505-0720-001 · OMB 0720-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHA 780 Professional Qualifications Medical/Peer Reviewers	Form and Instruction
Form DHA 780 PROFESSIONAL QUALIFICATIONS MEDICAL/PEER REVIEWERS Professional Qualifications Medical/Peer Reviewers	Form and Instruction
DHA 780 PROFESSIONAL QUALIFICATIONS MEDICAL/PEER REVIEWERS DHA780_ProfQualMedPeerReview_DRAFT_20250624_v2_RE.pdf	Form and Instruction
DHA 780 PROFESSIONAL QUALIFICATIONS MEDICAL/PEER REVIEWERS DHA780_ProfQualMedPeerReview_DRAFT_20250624_v2_RE.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0720-0005

Is this a Common Form? No

IC Status: Modified

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	DHA 780				Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	2,000	2,000

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.

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