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PHYSICIANS STATEMENT Student Name:Date of Birth:Program and Country of Study: Dates of Study Abroad Program: To the Examining Physician: The new and strenuous environment each student faces while
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OMB approval no1405-0119 is a control number assigned by the Office of Management and Budget to denote approval for a specific information collection request.
Entities or individuals specified in the information collection request are required to file OMB approval no1405-0119.
The OMB approval form must be completed according to the instructions provided in the information collection request.
The purpose of OMB approval no1405-0119 is to collect specific information from entities or individuals for regulatory or statistical purposes.
The specific information required to be reported on OMB approval no1405-0119 will be outlined in the information collection request.
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