Information Collection Request
Medical History and Examination
ICR 202307-1405-001 · OMB 1405-0068 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1405-0068 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form and Instruction |
Modified |
Form and Instruction |
Modified |
Justification for No Material/Nonsubstantive Change | 2023-07-10 |
Justification for No Material/Nonsubstantive Change | 2023-07-10 |
Supplementary Document | 2023-01-26 |
Supplementary Document | 2023-01-26 |
Supplementary Document | 2023-01-26 |
Supplementary Document | 2023-01-26 |
Supplementary Document | 2023-01-26 |
Supplementary Document | 2023-01-26 |
Supporting Statement A | 2023-04-03 |
Supporting Statement A | 2023-04-03 |
Form DS-1622 Medical History and Examination
Non - Substantive change DS-1843.docx
1405-0068 30-day Published.pdfIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 14884 | Modified | ||
| 14884 | Modified |
Medical History and ExaminationICR Details
| Status | Active |
|---|---|
| Agency/Subagency | STATE/AFA |
| OMB Control No | 1405-0068 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202301-1405-006 |
| Date Submitted to OIRA | 2023-07-10 |
| Requested Expiration Date | 1969-12-31 |