Form 1461 Privacy Notice - Antarctica

NATIONAL SCIENCE FOUNDATION
4201 WILSON BOULEVARD
ARLINGTON, VIRGINIA 22230
PRIVACY NOTICE
Medical Examination Records for Service in Polar Regions
The National Science Foundation’s Office of Polar Programs is responsible for ensuring that all personnel traveling to the polar
regions under the auspices of the United States meet certain medical standards. This medical screening process requires that
certain medical records be generated on each individual participating in the program.
The information requested on NSF provided forms is solicited under the authority of the National Science Foundation Act of
1950, as amended, 42 U.S.C. 1870 et seq. It will be used by NSF and its contractors and subcontractors in the medical
screening process to determine whether an applicant is qualified for deployment to the polar regions. An individual medical
file will include information collected to determine whether one is qualified for assignment to the polar regions, as well as
clinical files that may be generated if one receives medical treatment in any of the US sponsored medical clinics in Antarctica
or in the Arctic, as well as any off-ice treatment facilities arranged by the NSF or its contractor or subcontractor.
The records are used for three primary purposes: (1) to determine the individual’s fitness for assignment in the polar regions,
including individual waiver requests; (2) to assist in determining an appropriate course of medical/dental treatment should the
individual seek medical care with any medical care provider while deployed; and (3) to provide documentation for addressing
quality of care issues associated with these medical functions.
Records contained within this system may be released to individuals involved in those three functions. Such individuals
include, in addition to designated NSF employees as needed for assigned duties: (a) designated medical care practitioners and
their administrative support personnel including designated contractors and subcontractors involved in determining an
individual’s fitness for Antarctic or Arctic assignment, including individual waiver requests; (b) medical care providers during
deployment including those in NSF-supported stations and field camps in the polar regions where the individual is assigned;
and (c) medical experts advising the NSF on quality of medical care issues associated with NSF’s polar research programs. In
addition to these purposes, information in the medical records may be released to the individual’s personal or examining
physician or the individual’s designated emergency point of contact when disclosure is necessary to determine initial medical
clearance or to review treatment options if the individual requires medical attention while on assignment in the polar regions.
The determination of whether the individual is physically qualified/not physically qualified (PQ/NPQ) may be released to
representatives of the individual’s sponsoring organization including academic institutions, and investigators on a grant to
inform them whether an individual is approved for deployment or not.
If necessary, information may be released to Federal, state, or local agencies, or foreign governments when disclosure is
necessary to obtain records in connection with an investigation by or for the NSF; and to another Federal agency, a court, or a
party in litigation before a court or in an administrative proceeding if the government is a party, or when NSF determines that
the litigation or anticipated litigation or proceeding is likely to affect the Agency.
Submission of the information requested is voluntary. However, if you fail to provide any of the requested information, NSF or
its contractor may be unable to process or to approve your application for polar deployment.
More detail about how and where these records are maintained in accordance with the Privacy Act, 5 U.S.C. 552a, is contained
in the National Science Foundation’s System of Records Notice, Medical Examination Records for Service in the Polar
Regions, available upon request from the NSF 1 . No disclosure of information contained in your medical file will be made
except as described by the NSF’s System Notice or as otherwise authorized by law. You may request a copy of your records
for review.

1

For a copy of the System Notice, please contact the OPP Safety and Health Officer at NSF at (703) 306-1032, or write to Safety and
Health Officer, Office of Polar Programs, National Science Foundation, 4201 Wilson Blvd., Suite 755, Arlington, VA 22230.

NATIONAL SCIENCE FOUNDATION
4201 WILSON BOULEVARD
ARLINGTON, VIRGINIA 22230

OFFICE OF POLAR PROGRAMS

Medical Risks for NSF-Sponsored Personnel Traveling to the Polar Regions
Travel to the polar regions imparts certain risks to the traveler, because of harsh environmental conditions encountered,
limitations in the medical care available, and difficulties, in emergencies, of providing timely evacuation to tertiary
medical care facilities in the U.S. or other countries in the polar regions. United States polar programs participants should
consider these risks before deciding to deploy to the polar regions.
Greenland, the world’s largest island, is located in the Arctic region and is characterized by an extreme climate.
Whenever you are in an arctic area you can expect changeable weather and must be prepared for all kinds of weather. The
Polar Circle crosses the country south of Sisimiut/Holsteinsborg. Therefore, a great part of Greenland has dark winters
and the midnight sun in the summertime. The temperatures vary between minus 5 degrees Celsius to minus 30 degrees
Celsius in the winter and plus 5 degrees Celsius to plus 15 degrees Celsius in the summer. Generally the climate is Arctic,
the main temperature being zero to subzero. The maximum temperature in the warmest month is 12 degrees Celsius. The
coldest months are February and March. However, the temperatures do not feel as cold as in Europe as the wind is very
dry. Greenland can only be reached by airplane.
It is important that polar participants recognize these limitations in medical care while they are deployed. It is, in part,
because of these limitations, that the NSF requires medical and dental screening of personnel prior to deployment to the
polar regions. These medical screening examinations are necessary to determine the presence of medical conditions that
could threaten the health or safety of the individual while deployed. Persons who fail to meet these medical/dental
screening criteria will be notified of the specific reason(s) for their disqualification. Disqualified individuals may request
reconsideration by completing a waiver request package (obtained from the designated NSF support contractor).
Pre-deployment screening can identify existing medical conditions that may be difficult or impossible to treat effectively
in the polar regions. Participants should realize that serious accidents or injuries might challenge the medical care system,
as well. Therefore, individuals should recognize the limitations in the medical care system before they engage in any risktaking behaviors (whether on-the-job or during recreational pursuits) that may result in accidents or injuries.
Data collected as a result of this medical screening requirement are maintained in accordance with the Privacy Act (5 USC
552a) of 1974 and protected against unauthorized release, as described in the appended Privacy Notice.
I have read and understand this information sheet.

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Print Name

NSF Form 1461 Page 1 of 1 (APR 2002)
OMB CONTROL NUMBER 3145-0177: Expires SEP 2010

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Signature and Date

Original: Contractor Medical Staff

Applicant: Please retain a copy for your records