View Information Collection (IC)

View Information Collection (IC)

Medical Examination for Immigrant or Refugee Applicant
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DS-2053 Medical Examination for Immigrant or Refugee Applicant DS-2053.pdf Yes No Paper Only
Form DS-3024 Chest X-Ray and Classification Worksheet DS-3024.pdf Yes No Paper Only
Form DS-3025 Vaccination Documentation Worksheet DS-3025.pdf Yes No Paper Only
Form DS-3026 Medical History and Physical Examination Worksheet DS-3026.pdf Yes No Paper Only
Form DS-3025 Vaccination Documentation Worksheet ds3025 (rev 1-08).pdf Yes No Paper Only

Health Public Health Monitoring

 

630,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 630,000 0 0 0 0 630,000
Annual IC Time Burden (Hours) 630,000 0 0 0 0 630,000
Annual IC Cost Burden (Dollars) 283,500,000 0 31,500,000 0 0 252,000,000

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.