Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Health History Form (PC 1789) Removed 0 0 0 Form and Instruction PC-1789
Health History Form 2026 (PC 1789) New 12500 6250 0 Form and Instruction PC-1789
Total burden requested under this ICR: 12500 6250 0  
To view an IC, click on IC Title