NSF 1422, Polar Physical Examination - Medical History - Antarctica

Medical Clearance Process for Deployment to the Polar Regions

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1422 NSF 1422, Polar Physical Examination - Medical History - Antarctica Form and Instruction
1422 Polar Phsyical Examination - Medical History NSF 1422 1-2011 Version.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	NSF 1422, Polar Physical Examination - Medical History - Antarctica	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 675

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1422	Polar Phsyical Examination - Medical History	NSF 1422 1-2011 Version.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 Regsion	FR Citation: 62 FR 59895

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,000	-600	3,600
Annual IC Time Burden (Hours)	3,000	-600	3,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.