Supporting Statement 1405-0230

SUPPORTING STATEMENT FOR
PAPERWORK REDUCTION ACT SUBMISSION

Request to Add Afghan Parolees to eMedical Data Collection

OMB Number 1405-0230

DS-7794

A. JUSTIFICATION

1. Why is this collection necessary and what are the legal statutes that allow this?

With respect to the newly proposed collection, as a result of the Afghan evacuation and Operation Allies Welcome, the Department of State is requesting emergency approval to use the eMedical portal to collect health information for Afghan evacuees paroled into the United States and for Afghan evacuees who are located abroad and seeking permission to apply for parole in the United States (“parolees”). These evacuees paroled into the United States are coming from areas that have limited healthcare access and were placed in congregate settings during the evacuation process, raising the risk of spread of communicable diseases.

The Department of Homeland Security, with input from CDC set the medical conditions under which an Afghan national could legally enter the US. One of the conditions of parole, is that the parolees meet certain medical requirements, such as obtaining or confirming receipt of certain vaccinations, undergoing tuberculosis testing, and providing information about significant medical history and conditions. Some of these parolees may also undergo a full medical examination as part of a Special Immigrant Visa application process managed by the U.S. Citizenship and Immigration Services (USCIS).

Submitting this information into the eMedical system is necessary to fulfill the U.S. Centers for Disease Control and Prevention’s (CDC) public health obligation to notify and share health information of those paroled into the United States with state and local health departments to facilitate any needed medical care to reduce the risk of transmission and spread of communicable diseases in U.S. communities.

The Secretary of Health and Human Services (HHS) has statutory authority to prevent the introduction, transmission, and spread of communicable diseases into the United States (42 U.S.C. § 264). These functions are also carried out by the Director of the CDC. In furtherance of carrying out this authority, CDC has promulgated regulations at 42 CFR Parts 70 and 71. Under 42 CFR 71.20, CDC may conduct public health prevention measures, at U.S. ports of entry or other locations, through non-invasive procedures, as defined in section 42 CFR 71.1, to detect the potential presence of communicable diseases. It is under this authority CDC will receive health and contact information from medical examinations of those who are being, or those who are expected to be, paroled into the United States, performed by qualified physicians, have it recorded into the eMedical system, and then shared with state health departments.

2. What business purpose is the information gathered going to be used for?

The purpose of collecting parolee health and contact information through eMedical is to allow transfer of health information to CDC’s Electronic Disease Notification (EDN) system, a system that actively notifies U.S. public health departments and/or other authorized healthcare providers serving noncitizens who arrive in their jurisdictions to reduce the risk of transmission and spread of communicable diseases in U.S. communities. This information will be shared with relevant state health departments so they can share with local health departments to facilitate any needed medical care to reduce risk of communicable disease spread. It also helps reduce duplication in vaccination of these populations and costs if state health departments know which vaccines have already been provided. Please refer to the table below for the information that will be collected from the parolee during the medical information when performed in the US. For parolees, overseas all of the data in the DS-7794 (eMedical) will be collected.

Data Elements from eMedical (when used in the US)
Family name Given name(s) Gender Date of birth Country of Birth City of Birth Prior Country of Residence Country of Nationality Applicant category Identity document presented Number/ID Issuing Country Date of Issue Date of Expiry Other identifiers Record results Exam date History Signs of symptoms of TB Recent contact with known TB case Pregnant on the day of exam Food or drug allergies/Specify Current medications (List of all current medications) Physical Vitals Hearing and ears Nose, mouth, and throat (include dental) Eyes Heart (S1, S2, mumur, rub) Lungs (auscultation) TB Screening (and Corresponding Data) Chest X-Ray (and Corresponding Data) Sputum Culture Results (and Corresponding Data) TB Classification Remarks General supporting comments Vaccination Record Results (and Corresponding Data) Remarks

3. Is this collection able to be completed electronically (e.g. through a website or application)?

For data collection of parolees in the United States and outside of the United States, approved panel physicians, DOD full time staff, contractors and International Organization for Migration (IOM) staff will be granted access to the eMedical system by the CDC. The parolee’s health and contact information will be input into the eMedical portal and electronically sent to CDC’s EDN system that will notify the relevant U.S. public health department and/or other authorized healthcare provider that a parolee has entered their jurisdiction and may need medical care. Using electronic notifications is preferred since it allows for more rapid notification to states.

4. Does this collection duplicate any other collection of information?

Similar information is collected on paper (DOD SF-600, USCIS I-693, and the Department’s paper immigrant visa medical exam)

The electronic data are not maintained elsewhere or otherwise available.

5. Describe any impacts on small business.

The information collection does not involve small business or other small entities.

6. What are the consequences if this collection is not done?

Not collecting health information for Afghan parolees and sharing it with U.S. public health departments and other authorized healthcare providers could result in a higher risk of transmission and spread of communicable disease outbreaks in U.S. communities if Afghan parolees are not able to receive any needed medical care. Additionally, if public health departments do not receive documentation of vaccine doses the parolees have already received, that could result in parolees being either re-vaccinated unnecessarily, or completely missing the next dose for which they were scheduled.

7. Are there any special collection circumstances?

No special circumstances exist.

8. Document publication (or intent to publish) a request for public comments in the Federal Register

The Department will publish a notice in the Federal Register soliciting public comments on the proposed changes to the DS-7794 to include the above reference population, as well as notice of the request for emergency processing and approval by OMB in accordance with the requirements of the Paperwork Reduction Act. While the information collection revision will take effect immediately, the Department will take comment on the emergency clearance for 30 days.

9. Are payments or gifts given to the respondents?

No payment or gift is provided to respondents.

10. Describe assurances of privacy/confidentiality.

To the extent applicable to an individual parolee, under CDC’s System of Records Notice 09-90-2001, Records Used for Surveillance and Study of Epidemics, Preventable Diseases and Problems, CDC will share health information about parolees with U.S. public health departments and other authorized healthcare providers to facilitate medical care to these populations as needed to protect their health and the public health of U.S. communities.

11. Are any questions of a sensitive nature asked?

The eMedical form collects health and medical information of a sensitive nature for parolees. These questions on the collection are designed to solicit the medical information necessary to assist U.S. public health departments and other authorized healthcare providers in providing medical and public health follow up to individuals who have received humanitarian parole to enter the United States.

12. Describe the hour time burden and the hour cost burden on the respondent needed to complete this collection

The time it takes to administer a medical examination to Afghan parolee is estimated to be approximately 30 minutes. Therefore, total burden hours could be approximately 200,000 hours, when using the high-end estimate of 400,000 persons required to have an examination.

Based on the average U.S. hourly wage of $27.07¹ the weighted wage hour cost burden for this collection is approximately $4,060,500. This is based on the calculation of 1 hour x $27.07 (average hourly wage) x 1.5 (weighted wage multiplier, which adjusts the average hourly wage to a “fully loaded” salary, including, e.g., benefits, etc.) x 400,000 respondents = $16,242,000.

13. Describe the monetary burden to respondents (out of pocket costs) needed to complete this collection.

There would be no cost to the parolee for their medical examination.

14. Describe the cost incurred by the Federal Government to complete this collection.

The CDC anticipates the data entry of parolee information will cost $6,115,000. These costs fall into the following categories:

• DOD Data Entry Contract: $6,000,000 ($1,500,000/3months x 4 renewals)

• eMedical developer time to update eMedical to accept parolee information: $115,000

15. MExplain any changes/adjustments to this collection since the previous submission

The burden has increased from the last submission to OMB, reflective of an additional 400,000 respondents. The Department is requesting to temporarily add an additional pool of applicants to the data collection for eMedical. These are the 400,000 Afghan nationals who fled Afghanistan in August 2021 during the fall of its government to the Taliban.

16. Specify if the data gathered by this collection will be published.

Some parolee health information may be published for evaluation purposes, but it would be de-identified and follow the requirements in CDC’s System of Records Notice 09-90-2001, Records Used for Surveillance and Study of Epidemics, Preventable Diseases and Problems.

17. If applicable, explain the reason(s) for seeking approval to not display the OMB expiration date.

The Department will display the expiration date for OMB approval of the information collection.

18. Explain any exceptions to the OMB certification statement below.

The Department is not requesting any exception to the certification statement.

B. COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

This collection does not employ statistical methods.

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