Worksheet for Identifying Medical Conditions among Refugees and Immigrants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Worksheet for Identifying Medical Conditions among Refugees and Immigrants	Form and Instruction	New	Repair queued
Attachment 6. Public Comments.pdf	Supplementary Document	Uploaded 2007-06-12	Repair queued
Attachment 5. 60-day FRN.pdf	Supplementary Document	Uploaded 2007-06-12	Repair queued
Attachment 3. 42CFR34.pdf	Supplementary Document	Uploaded 2007-06-12	Repair queued
Attachment 2. Delegation under INA.pdf	Supplementary Document	Uploaded 2007-06-12	Repair queued
Attachment 1. Authorizing Leg.pdf	Supplementary Document	Uploaded 2007-06-12	Repair queued
SS Worksheet for Identifying Medical Conditions.doc	Supporting Statement A	Uploaded 2007-06-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181025	Worksheet for Identifying Medical Conditions among Refugees and Immigrants	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200707-0920-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Worksheet for Identifying Medical Conditions among Refugees and Immigrants
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/22/2007
	Date Received in OIRA: 07/03/2007
Terms of Clearance: Withdrawn per CDC request. CDC shall coordinate the next submission of this collection of information to OMB for review with the relevant proposed regulation.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is requesting OMB approval for a Worksheet for Medical Conditions among Refugees and Immigrants to be used by State and local health refugee coordinators to identify specific medical conditions of public health importance in newly arrived refugees and immigrants. CDC requests notification of specific medical conditions listed on the worksheet, including Class A and B health conditions not recognized overseas and substantial discrepancies in the overseas and U.S. based medical evaluations. Section 412 of the Immigration and Nationality Act (INA) (8 U.S.C. 1522(b)(4)) authorizes the Secretary of Health and Human Services, Department of Health and Human Services (DHHS) to: (A) assure than an adequate number of trained staff are available at the location at which the refugees enter the United States to assure that all necessary medical records are available and in proper order; (B) provide for the identification of refugees who have been determined to have medical conditions affecting public health and requiring treatment; (C) assure that State or local health officials at the resettlement destination of each refugee within the United States are promptly notified of the refugee's arrival and provided with all applicable medical records; and (D) provide for such monitoring of refugees identified under subparagraph (B) as will insure that they receive appropriate treatment and timely treatment. The Secretary, DHHS, has delegated this authority to CDC. Currently the Department of State uses medical examination forms, under OMB Control Number 1405-0113, to conduct the overseas medical evaluation of refugees and immigrants. This worksheet will provide State and local health officials with accurate information to permit follow-up of significant health events and will help prevent spread of disease.

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Authorizing Statute(s): US Code: 8 USC 412 Name of Law: Immigration and Nationality Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 36346	06/26/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32297	06/12/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Worksheet for Identifying Medical Conditions among Refugees and Immigrants	None	Worksheet for Identifying Medical Conditions among Refugees and Immigrants

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection activity.

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Annual Cost to Federal Government: $8,313

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/03/2007

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