Information Collection

Medical Examination for Immigrant or Refugee Applicant

IC 274498 under ICR 202601-1405-002 · OMB 1405-0113.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-3025 Medical Examination for Immigrant or Refugee Applicant	Form and Instruction
Form DS-3025 Vaccination Documentation Worksheet Medical Examination for Immigrant or Refugee Applicant	Form and Instruction
DS-3025 Vaccination Documentation Worksheet DS-3025 COVID Update.pdf	Form and Instruction
DS-3025 Vaccination Documentation Worksheet DS-3025 COVID Update.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	DS-3025				No		Paper Only

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title: SORN Visa Records, State-39

FR Citation: 60 FR 148

Number of Respondents: 110,412

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	110,412	110,412
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

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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