OMB control number

Department of Defense Medical Examination Review Board Medical Information Collection Forms

OMB 0704-0396 · DOD/DODDEP.

OMB 0704-0396

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form DD Form 2492 DoD Medical Examination Review Board (DoDMERB) Report of Medical History	Form
Form DD Form 2489 DoD Medical Examination Review Board (DoDMERB) Farnsworth lantern and Red/Green Color Vision Tests	Form
Form DD Form 2382 DoD Medical Examination Review Board (DoDMERB) Statement of History Regarding Allergies	Form
Form DD Form 2381 DoD Medical Examination Review Board (DoDMERB) Statement of History Regarding Motion Sickness	Form
Form DD Form 2380 DoD Medical Examination Review Board (DoDMERB) Statement of History Regarding Sleepwalking	Form
Form DD Form 2379 DoD Medical Examination Review Board (DoDMERB) Statement of History Regarding Head Injury	Form
Form DD Form 2378 DoD Medical Examination Review Board (DoDMERB) Statement of History Regarding Headaches	Form
Form DD Form 2374 DoD Medical Examination Review Board (DoDMERB) Heart Murmur Evaluation	Form
Form DD Form 2372 DoD Medical Examination Review Board (DoDMERB) Statement of Present Health	Form
Form DD Form 2370 DoD Medical Examination Review Board (DoDMERB) Three Day Blood Pressure and Pulse Check	Form
Form DD Form 2369 DoD Medical Examination Review Board (DoDMERB) Cycloplegic Refraction	Form
Form DD Form 2351 DoD Medical Examination Review Board (DoDMERB) Report of Medical Examination	Form
0704-0396 SS Part A.doc	Supporting Statement A
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form
Department of Defense Medical Examination Review Board Medical Information Collection Forms	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
200608-0704-006	Extension without change of a currently approved collection	2006-08-29	Approved without change
200307-0704-001	Extension without change of a currently approved collection	2003-07-08	Approved without change
200005-0704-007	Extension without change of a currently approved collection	2000-05-30	Approved without change
199705-0704-002	Existing collection in use without an OMB Control Number	1997-05-19	Approved without change