OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Peace Corps Health History Form

OMB 0420-0510 ยท PEACE.

OMB 0420-0510

All Peace Corps Volunteer applicants must undergo a physical examination prior to service during the application process to ensure good health and be able to serve without undue disruption due to health problems.

The latest form for Peace Corps Health History Form expires 2029-09-30 and is listed under ICR 202509-0420-001.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form PC-1789 Health History FormForm and Instruction
Form PC-1789 Health History FormForm and Instruction
Supporting Statement 0420-0510 Health History Form.docxSupporting Statement A
PC-17.pdfSupplementary Document
PC 1789 Health History Form 2025 Form and Instruction
Health History Form (PC 1789) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202509-0420-001 Reinstatement with change of a previously approved collection 2025-09-30
202407-0420-002 Reinstatement without change of a previously approved collection 2024-08-23
202011-0420-006 Reinstatement without change of a previously approved collection 2020-11-17
201612-0420-002 Revision of a currently approved collection 2016-12-20 Approved with change
201610-0420-005 Revision of a currently approved collection 2016-11-02 Improperly submitted and continue
201401-0420-004 Extension without change of a currently approved collection 2014-02-10 Approved without change
201201-0420-002 Revision of a currently approved collection 2012-01-30 Approved with change
201103-0420-001 Revision of a currently approved collection 2011-06-21 Approved without change
200705-0420-010 Reinstatement without change of a previously approved collection 2008-02-26 Approved with change
200312-0420-001 Extension without change of a currently approved collection 2003-12-29 Approved without change
200011-0420-001 Extension without change of a currently approved collection 2000-11-01 Approved without change
199708-0420-001 Reinstatement without change of a previously approved collection 1997-08-21 Approved without change
199702-0420-002 Extension without change of a currently approved collection 1997-02-03 Withdrawn
199408-0420-001 Reinstatement with change of a previously approved collection 1994-08-22 Approved without change
199106-0420-001 Reinstatement with change of a previously approved collection 1991-06-17 Approved without change
198804-0420-001 New collection (Request for a new OMB Control Number) 1988-04-12 Approved without change

OMB Details

Health History Form (PC 1789)

Federal Enterprise Architecture: International Affairs and Commerce - International Development and Humanitarian Aid

Information collection instruments
FormNameElectronic accessType
Form PC-1789Health History FormFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.