Information Collection Request

Medical Clearance Process for Deployment to the Polar Regions

ICR 201404-3145-001 · OMB 3145-0177 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form NSF-1700 Medical Clearance Process for Deployment to the Polar Regions Form and Instruction New Available
Form 1461 NSF 1461, Privacy Notice, Antarctica Form and Instruction Removed Repair queued
Form 1458 NSF 1458, Personal Information Form Form and Instruction Removed Repair queued
Form 1457 NSF 1457, Important Notice for Participants in the United States Antarctic Program Form and Instruction Removed Repair queued
Form 1429-I NSF 1429-I, Individual Statement of Sujpport Form and Instruction Removed Repair queued
Form 1429-B NSF 1429-B, Employer Statement of Support for Waiver Request-Arctic Form and Instruction Removed Repair queued
Form 1429-A NSF 1429-A, Employer Statement of Support for Waiver Request-Antarctic Form and Instruction Removed Repair queued
Form 1428-B NSF 1428-B, Request for Waiver of NSF/OPP Medical Requirements-Arctic Form and Instruction Removed Repair queued
Form 1428-A NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica Form and Instruction Removed Repair queued
Form 1425-B NSF 1425-B, Polar Dental Examination - Arctic Form and Instruction Removed Repair queued
Form 1423-C NSF 1423-C, Polar Physical Examination Form and Instruction Removed Available
Form 1423-B NSF 1423-B, Polar Physical Examination Form and Instruction Removed Available
Form 1421 NSF 1421-B, Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions - Arctic Form and Instruction Removed Repair queued
Form 1427 NSF 1427, Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years Form and Instruction Removed Repair queued
Form 1425-A NSF 1425-A, Polar Dental Examination - Antarctica Form and Instruction Removed Available
Form 1424 NSF 1424, Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test Form and Instruction Removed Available
Form 1423 NSF 1423-A, Polar Physical Examination - Antarctica Form and Instruction Removed Available
Form 1422 NSF 1422, Polar Physical Examination - Medical History - Antarctica Form and Instruction Removed Available
Form 1421-A NSF 1421-A, Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica Form and Instruction Removed Repair queued
31450177 Supporting Statement 2014.docx Supporting Statement A Uploaded 2014-04-28 Available
Presidential Memo 6646.pdf Supplementary Document Uploaded 2014-04-28 Available
42 USC 1870.pdf Supplementary Document Uploaded 2014-04-28 Available
45cfr675.pdf Supplementary Document Uploaded 2007-09-19 Available
privacy act.pdf Supplementary Document Uploaded 2007-09-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
211404 Medical Clearance Process for Deployment to the Polar Regions Form and Instruction New
182110 Privacy Notice - Arctic Other-Privacy Notice for Potential Participants Removed
182109 Privacy Notice, Antarctica Other-Privacy Notice for Potential Participants Removed
182107 NSF 1461, Privacy Notice, Antarctica Form and Instruction Removed
182105 NSF 1458, Personal Information Form Form and Instruction Removed
182104 NSF 1457, Important Notice for Participants in the United States Antarctic Program Form and Instruction Removed
182103 NSF 1429-I, Individual Statement of Sujpport Form and Instruction Removed
182102 NSF 1429-B, Employer Statement of Support for Waiver Request-Arctic Form and Instruction Removed
182101 NSF 1429-A, Employer Statement of Support for Waiver Request-Antarctic Form and Instruction Removed
182100 NSF 1428-B, Request for Waiver of NSF/OPP Medical Requirements-Arctic Form and Instruction Removed
182099 NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica Form and Instruction Removed
182098 NSF 1425-B, Polar Dental Examination - Arctic Form and Instruction Removed
182097 NSF 1423-C, Polar Physical Examination Form and Instruction Removed
182096 NSF 1423-B, Polar Physical Examination Form and Instruction Removed
182095 NSF 1421-B, Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions - Arctic Form and Instruction Removed
182055 NSF 1427, Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years Form and Instruction Removed
182054 NSF 1425-A, Polar Dental Examination - Antarctica Form and Instruction Removed
182052 NSF 1424, Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test Form and Instruction Removed
182050 NSF 1423-A, Polar Physical Examination - Antarctica Form and Instruction Removed
182045 NSF 1422, Polar Physical Examination - Medical History - Antarctica Form and Instruction Removed
182043 NSF 1421-A, Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica Form and Instruction Removed
ICR Details
3145-0177 201404-3145-001
Historical Active 201101-3145-003
NSF
Medical Clearance Process for Deployment to the Polar Regions
Revision of a currently approved collection   No
Regular
Approved without change 06/19/2014
Retrieve Notice of Action (NOA) 04/28/2014
  Inventory as of this Action Requested Previously Approved
06/30/2017 36 Months From Approved 06/30/2014
3,300 0 27,965
33,600 0 34,907
1,075,008 0 0

The National Science Foundation requires all U.S. Antarctic participants and all participants deploying to Greenland and other select regions of the Arctic to take and pass a physical examination prior to deployment. NSF uses the information to determine the medical and dental health and psychological suitability of the polar participants; to determine whether accommodations exist to treat certain ailments and to provide on-site treatment, when needed, without doing harm. The respondents are all USAP participants; all Greenland participants in select regions of the Arctic that are under the auspices of USAP.

US Code: 42 USC 1870 Name of Law: General Authority of Foundation
  
None

Not associated with rulemaking

  78 FR 68479 11/14/2013
79 FR 23013 04/25/2014
No

1
IC Title Form No. Form Name
NSF 1423-A, Polar Physical Examination - Antarctica 1423 Polar Physical Exam
Medical Clearance Process for Deployment to the Polar Regions NSF-1700 Medical Clearance Process for Deployment to the Polar Regions
NSF 1422, Polar Physical Examination - Medical History - Antarctica 1422 Polar Phsyical Examination - Medical History
NSF 1421-A, Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica 1421-A Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica
NSF 1424, Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test 1424 Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test
NSF 1425-A, Polar Dental Examination - Antarctica 1425-A Polar Dental Examination
NSF 1427, Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years 1427 Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years
NSF 1421-B, Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions - Arctic 1421 Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions
NSF 1423-B, Polar Physical Examination 1423-B Polar Physical Exam
NSF 1423-C, Polar Physical Examination 1423-C Polar Physical Exam
NSF 1425-B, Polar Dental Examination - Arctic 1425-B Polar Dental Examination - Arctic
NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica 1428-A Request for Waiver of NSF/OPP Medical Requirements - Antarctica
NSF 1428-B, Request for Waiver of NSF/OPP Medical Requirements-Arctic 1428-B Request for Waiver of NSF/OPP Medical Requirements-Arctic
NSF 1429-A, Employer Statement of Support for Waiver Request-Antarctic 1429-A Employer Statement of Support for Waiver Request
NSF 1429-B, Employer Statement of Support for Waiver Request-Arctic 1429-B Employer Statement of Support for Waiver Request-Arctic
NSF 1429-I, Individual Statement of Sujpport 1429-I Individual Statement of Support
NSF 1457, Important Notice for Participants in the United States Antarctic Program 1457 Important Notice for Participants in the United States Antarctic Program
NSF 1458, Personal Information Form 1458 Personal Information Form
NSF 1461, Privacy Notice, Antarctica 1461, NSF 1461 Privacy Notice - Antarctica ,   Privacy Notice and Paperwork Reduction Act Statement
Privacy Notice, Antarctica
Privacy Notice - Arctic

  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 3,300 27,965 0 -24,665 0 0
Annual Time Burden (Hours) 33,600 34,907 0 -1,307 0 0
Annual Cost Burden (Dollars) 1,075,008 0 0 1,075,008 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The program has streamlined the format of the Polar Programs medical process, combining 15+ separate forms into one continuous packet, eliminating duplication and including a pre-filled format.

$0
No
No
No
No
No
Uncollected
Suzanne Plimpton

  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.
04/28/2014