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: 0420-0549	ICR Reference No: 202011-0420-004
Status: Historical Inactive	Previous ICR Reference No: 201611-0420-002
Agency/Subagency: PEACE	Agency Tracking No: PC-1790s
Title: Report of Physical Examination
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 10/20/2022
	Date Received in OIRA: 11/17/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	5,600	0	0
Time Burden (Hours)	8,400	0	0
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $63,750

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Virginia Burke 202 692-1887 vburke@peacecorps.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.