CERTIFICATE OF MEDICAL EXAMINATION (PRE-EMPLOYMENT)

ICR 199608-0583-001

OMB: 0583-0062

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
37043
Migrated
ICR Details
0583-0062 199608-0583-001
Historical Active 199308-0583-002
USDA/FSIS
CERTIFICATE OF MEDICAL EXAMINATION (PRE-EMPLOYMENT)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/27/1996
Retrieve Notice of Action (NOA) 08/27/1996
  Inventory as of this Action Requested Previously Approved
08/31/1996 08/31/1996 09/30/1996
600 0 600
150 0 150
0 0 0

THE CERTIFICATE OF MEDICAL EXAMINATION (PRE-EMPLOYMENT), FORM FSIS-4339-1, IS USED TO DETERMINE IF THE APPLICANT IS PHYSICALLY CAPAB OF PERFORMING SPECIFIED DUTIES AND IS FREE OF CONTAGIOUS DISEASES.

None
None


No

1
IC Title Form No. Form Name
CERTIFICATE OF MEDICAL EXAMINATION (PRE-EMPLOYMENT)

  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 600 600 0 0 0 0
Annual Time Burden (Hours) 150 150 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
08/27/1996


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