Information Collection

Fitness-For-Duty Medical Certifications

IC 178654 under ICR 201003-1235-003 · OMB 1235-0003.

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Information Collection (IC) Details

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IC Title:	Fitness-For-Duty Medical Certifications	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 825.100(d) 29 CFR 825.310

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 411,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-411,000	203,500	207,500
Annual IC Time Burden (Hours)	-68,500	33,917	34,583
Annual IC Cost Burden (Dollars)	-3,501,720	2,887,520	614,200

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