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 and Instruction DS-2053 Medical Examination for Immigrant or Refugee Applicant (1991 TI) DS-2053.pdf Yes No Printable Only
Form and Instruction DS-2054 Medical Examination for Immigrant or Refugee Applicant (2007 TI) DS-2054.pdf Yes No Printable Only
Form and Instruction DS-3024 Chest X-Ray and Classification Worksheet (1991TI) DS-3024.pdf Yes No Printable Only
Form and Instruction DS-3025 Vaccination Documentation Worksheet DS-3025.pdf Yes No Printable Only
Form and Instruction DS-3026 Medical History and Physical Examination Worksheet DS-3026.pdf Yes No Printable Only
Form and Instruction DS-3030 Chest X-Ray and Classification Worksheet (2007 TI) DS-3030.pdf Yes No Printable Only
Form and Instruction Main Medical Form Medical Examination for Immigrant or Refugee Applicant (Canada) Canada MainMedForm.pdf Yes No Printable Only
Form and Instruction Medical Worksheet One Chest X-Ray and Classification Medical Worksheet One (Canada) Canada MedWksht1.pdf Yes No Printable Only
Form and Instruction Medical Worksheet Two Vaccination Documentation Medical Worksheet Two (Canada) Canada MedWksht2.pdf Yes No Printable Only
Form and Instruction Medical Worksheet Three Medical History and Physical Examination Medical Worksheet Three (Canada) Canada MedWksht3.pdf Yes No Printable Only
Form and Instruction DS-2053 Medical Examination for Immigrant or Refugee-1991 TI (11-2009) DS-2053 11-23-09.pdf Yes No Printable Only
Form and Instruction DS-2054 Medical Examination for Immigrant or Refugee Applicant - 2007 TI (11-2009) DS-2054 11-23-09.pdf Yes No Printable Only
Form and Instruction DS-3030 Chest X-Ray and Classification Worksheet - 2007 TI (11-2009) DS-3030 11-23-09.pdf Yes No Printable Only
Form and Instruction Main Medical Form Medical Examination for Immigrant or Refugee Applicant (Canada) (11-2009) Canada MainMedForm 11-23-09.pdf Yes No Printable 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 0 0 0 283,500,000

Title Document Date Uploaded
Canadian Forms Justification (4-09) Canadian Forms Justification.doc 04/09/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.