USAID Contractor Employee Physical Examination Form

ICR 200010-0412-001

OMB: 0412-0536

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
848 Migrated
ICR Details
0412-0536 200010-0412-001
Historical Active 199706-0412-001
AID
USAID Contractor Employee Physical Examination Form
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 02/05/2001
Retrieve Notice of Action (NOA) 10/06/2000
The agency is instructed to conduct a review of this information collection to clarify the need for the two page form collected from the individual and provided to the doctor and to ensure that future submissions accurately reflect this portion of the collection. The agency must also review both forms to ensure that all information is necessary, including the question on the race of the respondent. Finally, the agency must review its Privacy Act compliance and ensure that applicants are fully informed of their rights under the Privacy Act and of all routine uses for the doctor's information. This approval includes as burden the $249,100 reported by the agency as a financial cost to the respondents for the medical exames. Future submissions must include nonlabor financial cost to the respondents.
  Inventory as of this Action Requested Previously Approved
08/31/2002 08/31/2002
1,460 0 0
8,760 0 0
249,000 0 0

USAID needs to use standardized medical examinations for contractors before their assignment to developing countries. By evaluating the employee's medical status in order to complete the examination form, the employee's physician will be better informed as to the possible health risks the employee will face and can better determine the employee's suitability for the assignment. The physican's determination may protect the employee and benefits USAID and the contractor by screening out persons with medical conditions for which adequate medical care is not available.

None
None


No

1
IC Title Form No. Form Name
USAID Contractor Employee Physical Examination Form AID-1420-62

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,460 0 0 1,460 0 0
Annual Time Burden (Hours) 8,760 0 0 8,760 0 0
Annual Cost Burden (Dollars) 249,000 0 0 249,000 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/06/2000


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