A.I.D. CONTRACTOR EMPLOYEE PHYSICAL EXAMINATION FORM

ICR 199001-0412-002

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
98834
Migrated
ICR Details
0412-0536 199001-0412-002
Historical Active
AID
A.I.D. CONTRACTOR EMPLOYEE PHYSICAL EXAMINATION FORM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/30/1990
Retrieve Notice of Action (NOA) 01/18/1990
In accordance with the Paperwork Reduction Act (PRA) and 5 CFR 1320, this collection of information is approved through May 31, 1991. This new information collection requirement should be reviewed after one year. AID's next request for OMB review should include the results of such a review, particularly with respect to costs incurred, relative changes in medical costs attributable to the policy, and the results of consultations with the contractors and posts affected. also justification should be given of the level of detail of information requested, particularly for mental health history.
  Inventory as of this Action Requested Previously Approved
05/31/1991 05/31/1991
1,650 0 0
6,600 0 0
0 0 0

A.I.D. NEEDS TO STANDARDIZE MEDICAL EXAMINATIONS FOR CONTRACTORS BEFOR THEIR ASSIGNMENT TO DEVELOPING COUNTRIES. INFORMATION COLLECTED IN THIS FORM WILL ENABLE A.I.D. AND THE STATE DEPARTMENT TO SCREEN OUT PERSONS WITH MEDICAL CONDITIONS FOR WHICH ADEQUATE MEDICAL CARE IS NOT AVAILABLE IN THE COUNTRY OF ASSIGNMENT.

None
None


No

1
IC Title Form No. Form Name
A.I.D. CONTRACTOR EMPLOYEE PHYSICAL EXAMINATION FORM

  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 1,650 0 0 1,650 0 0
Annual Time Burden (Hours) 6,600 0 0 6,600 0 0
Annual Cost Burden (Dollars) 0 0 0 0 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.
01/18/1990


© 2024 OMB.report | Privacy Policy