View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1615-0033	ICR Reference No: 200907-1615-004
Status: Historical Active	Previous ICR Reference No: 200803-1615-002
Agency/Subagency: DHS/USCIS	Agency Tracking No:
Title: Report of Medical Examination and Vaccination Record
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/14/2009
	Date Received in OIRA: 07/21/2009
Terms of Clearance: Approved for only two years due to limited GPEA compliance. DHS will be eligible for a full three-year approval on this form when it is electronically submittable.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved	10/31/2009
Responses	800,000	0	800,000
Time Burden (Hours)	2,000,000	0	2,000,000
Cost Burden (Dollars)	0	0	0

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