Health professionals applying to the
Corps will be required to complete form PHS-7060. The self-reported
medical history form requires 'yes' or 'no' answers. 'Yes' answers
will trigger additional questionnaires (PHS-7053-Allergies;
PHS-7054 Head Injury; PHS-7055-Injury; PHS-7056-Headache;
PHS-7057-Gyn; PHS-7061-Oswesty Low Back). The Medical Evaluation
Officer will use the form to determine medical suitability for the
Corps.
US Code:
37
USC 101 Name of Law: Uniformed Services of the United
States
US Code: 42
USC 204 Name of Law: Corps
The program changes includes
the restructuring of CCHQ. In the previous collection, the
Recruitment Branch performed review of medical documents submitted
by applicants applying to the Corps to ensure applicants meet
medical accession standards. With the restructuring of CCHQ, the
Medical Affairs Branch (MAB) is responsible for the medical
accession of applicants. Additionally, CCHQ entered into agreement
with the Department of Defense Medical Examination Review Board
(DoDMERB) and the Department of Defense Medical Exam Testing System
(DoDMETS). DoDMETS will coordinate scheduling and conducting
medical examinations and forward the examinations electronically to
DoDMERB for review. Additionally, MAB retired PHS forms of PHS-7059
(Report of Medical Examination), PHS-6379 Supplemental Medical
History Record Required of Applicants to the Public Health Service
Commissioned Corps; Form PHS-7053 (Allergies Questionnaire)
PHS-7054 (Head Injury Questionnaire), PHS-7055 (Injury
Questionnaire), PHS-7056 (Headache Questionnaire), PHS-7057 (GYN
Questionnaire), PHS-7061 (Owestr Low Back Questionnaire)
$50,000
No
Yes
Yes
No
No
No
No
Sherette Funn-Coleman
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.