Medical History and Examination for Foreign Service

ICR 201308-1405-006

OMB: 1405-0068

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2013-09-11
Supplementary Document
2013-09-11
Supplementary Document
2013-08-16
Supplementary Document
2013-08-16
Supporting Statement A
2013-09-11
IC Document Collections
ICR Details
1405-0068 201308-1405-006
Historical Active 201109-1405-003
STATE/AFA
Medical History and Examination for Foreign Service
Revision of a currently approved collection   No
Emergency 08/23/2013
Approved with change 09/11/2013
Retrieve Notice of Action (NOA) 08/16/2013
  Inventory as of this Action Requested Previously Approved
03/31/2014 6 Months From Approved 02/28/2015
23,245 0 8,000
23,245 0 8,000
0 0 0

Pursuant to 22 U.S.C. § 4084, the Secretary of State has the authority to establish a Medical Program. This information collection provides to the U.S. Department of State's Office of Medical Services the material needed to determine whether a candidate for a Foreign Service appointment is able to obtain the medical clearance that is a requirement for that appointment, and to determine the appropriate medical clearances for other individuals who participate in the Medical Program.
The information collected in Form DS-1843 is needed to determine whether a candidate for a Foreign Service appointment can obtain the medical clearance that is a requirement of the appointment. Additionally, the information collected in Forms DS-1843 and DS-1622 is used to provide and to update medical clearances for individuals who participate in the Department of State’s Medical Program. The information collection is essential to the mission of the Foreign Service, and form revisions are needed to clarify that the information collection is consistent with applicable authorities.

PL: Pub.L. 110 - 233 122 Name of Law: Genetic Information Nondiscrimination Act of 2008
  
None

Not associated with rulemaking

  78 FR 159 08/16/2013
No

  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 23,245 8,000 0 15,245 0 0
Annual Time Burden (Hours) 23,245 8,000 0 15,245 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The number of respondents has had a significant increase since 2011 when the Office of Medical Clearances processed approximately 8,000 clearances.Changes on the form are due to meeting the requirements of GINA (Genetic Information Nondiscrimination Act of 2008).

$373,081
No
No
No
No
No
Uncollected
Susan Summers 703 875-5413 summerssb@state.gov

  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.
08/16/2013


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