Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Asthma Evaluation Form New 1400 2450 0 Form and Instruction PC-262-2
Cervical Cancer Screening Form New 7200 8400 0 Form and Instruction PC-262-11
Colon Cancer Screening Form New 575 1581 0 Form and Instruction PC-262-9
Diabetes Diagnosis Form New 110 193 0 Form and Instruction PC-262-3
ECG Form New 1150 767 0 Form and Instruction PC-262-7
Eating Disorder Treatment Summary Form New 564 1551 0 Form and Instruction PC-262-8
Functional Abilities Evaluation Form New 600 1350 0 Form and Instruction PC-262-15
Insulin Dependent Supplemental Documentation Form New 28 61 0 Form and Instruction PC-262-10
Mammogram Waiver Form New 148 259 0 Form and Instruction PC-355-2
Mental Health Current Evaluation and Treatment Summary New 2442 6716 0 Form and Instruction PC-262-14
Prescription for Eyeglasses Form New 6586 8233 0 Form and Instruction PC-OMS-116
Reactive Tuberculin Test Evaluation Form New 784 1764 0 Form and Instruction PC-262-12
Required Peace Corps Immunizations Form New 5600 5600 0 Form and Instruction PC-262-16
Substance-Related and Addictive Disorders Current Evaluation Form New 746 2798 0 Form and Instruction PC-262-6
Transfer of Care New 2540 4445 0 Form and Instruction PC-262-13
Total burden requested under this ICR: 30473 46168 0  
To view an IC, click on IC Title