Information Collection

NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica

IC 182099 under ICR 200708-3145-001 · OMB 3145-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3145-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1428-A NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica	Form and Instruction
1428-A Request for Waiver of NSF/OPP Medical Requirements - Ant 1428-A, Waiver Request.pdf	Form and Instruction

IC Title:

NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 675

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1428-A	Request for Waiver of NSF/OPP Medical Requirements - Antarctica	1428-A, Waiver Request.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: NSF-19, Medical Examination Records for Service in the Polar Regions

FR Citation: 62 FR 59895

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.