Information Collection

SEARCH Physical Examination

IC 197883 under ICR 201705-0920-019 · OMB 0920-0904.

Documents and Forms

Document Name Document Type
SEARCH Physical Examination Form
Physical Examination Form Attachment 4A3_Physical Examination Form r102017.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SEARCH Physical Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Physical Examination Form	Attachment 4A3_Physical Examination Form r102017.pdf		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 823	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	823	113	710
Annual IC Time Burden (Hours)	1,235	-895	2,130
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.