FSIS_certificate of medical examination supporting statement A_v.2

SUPPORTING STATEMENT JUSTIFICATION FOR

CERTIFICATE OF MEDICAL EXAMINATION INFORMATION COLLECTION

1. Circumstances Making Collection of Information Necessary:

This information collection requests a new information collection related to the collection of information related to certificates of medical examination associated with FSIS regulatory programs.

The Food Safety and Inspection Service (FSIS) has been delegated the authority to exercise the functions of the Secretary as provided in the Federal Meat Inspection Act (FMIA) (21 U.S.C. 601 et seq.), the Poultry Products Inspection Act (PPIA) (21 U.S.C. 451 et seq.), and the Egg Products Inspection Act (EPIA) (21 U.S.C. 1031 et seq.). These statutes mandate that FSIS protect the public by ensuring that meat and poultry products are safe, wholesome, unadulterated, and properly labeled and packaged.

FSIS will use the form titled Certificate of Medical Evaluation (FSIS 4339-1) to collect information to determine whether or not an applicant for an FSIS Food Inspector, Consumer Safety Inspector, or Veterinary Medical Officer in-plant position meets the Office of Personnel Management (OPM) approved medical qualification standards.

2. How, By Whom and Purpose For Which Information is to be Used:

The following is a discussion of the required information collection and recordkeeping activities.

FSIS plans to collect certificates of medical examination to determine whether or not an applicant for a Food Inspector, Consumer Safety Inspector, or Veterinary Medical Officer in-plant position meets the Office of Personnel Management (OPM)-approved medical qualification standards for the position. This new form, Certificate of Medical Evaluation (FSIS 4339-1), ensures accurate collection of the required data. The OPM-approved medical qualification standards apply only to positions in FSIS, not positions in other Federal agencies.

When requesting that applicants for the positions listed above undergo the medical examination, a representative of FSIS will notify the applicants in writing of the reasons for the examination, the process, and the consequences of the failure to report for an examination or provide medical documentation. Any physical condition which would hinder an individual’s full, efficient, and safe performance of his or her duties will be considered disqualifying for employment, except when convincing evidence is presented that the individuals can perform the essential functions of the job efficiently and without hazard to themselves or others.

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3. Use of Improved Information Technology:

Under the E-Gov Act, individuals may submit the forms electronically. FSIS makes available an electronic version (PDF fillable) of the FSIS Form 4339-1. The form can be filled out on the computer and then either emailed or printed off and submitted to the appropriate office.

4. Efforts to Identify Duplication:

FSIS has determined that this information collection will not duplicate any other information collections. The required records could be available through the use of OPM Optional Form 178 (OMB 3206-0250), but FSIS requires more extensive medical information in order to assess whether candidates meet the medical qualification standards for inspection positions. The forms in this collection are designed to improve data-gathering to align more closely with FSIS needs and save time by reducing the need for follow-up.

5. Methods to Minimize Burden on Small Business Entities:

There are no small businesses affected by this information collection.

6. Consequences If Information Were Collected Less Frequently:

To conduct the information collections less frequently will reduce the effectiveness of the meat and poultry products inspection program.

7. Circumstances that Would Cause the Information Collection to be Conducted in a Manner:

• requiring respondents to report informa­tion to the agency more often than quarterly;

• requiring respondents to prepare a writ­ten response to a collection of infor­ma­tion in fewer than 30 days after receipt of it;

• requiring respondents to submit more than an original and two copies of any docu­ment;

• requiring respondents to retain re­cords, other than health, medical, governm­ent contract, grant-in-aid, or tax records for more than three years;

• in connection with a statisti­cal sur­vey, that is not de­signed to produce valid and reli­able results that can be general­ized to the uni­verse of study;

• requiring the use of a statis­tical data classi­fication that has not been re­vie­wed and approved by OMB;

• that includes a pledge of confiden­tiali­ty that is not supported by au­thority estab­lished in statute or regu­la­tion, that is not sup­ported by dis­closure and data security policies that are consistent with the pledge, or which unneces­sarily impedes shar­ing of data with other agencies for com­patible confiden­tial use; or

• requiring respondents to submit propri­etary trade secret, or other confidential information unless the agency can demon­strate that it has instituted procedures to protect the information's confidentiality to the extent permit­ted by law.

There are no circumstances that would cause the guidelines above not to be met by this information collection.

8. Consultation with Persons Outside the Agency:

In accordance with the Paperwork Reduction Act, FSIS published a 60-day notice in the Federal Register on May 18, 2015 (80 FR 28220) requesting comments regarding this information collection request. The Agency received no comments in response to the Federal Register notice. FSIS requested comments from three knowledgeable people on the Certificate of Medical Information form. The commenters agreed that it will take 90 minutes or less to complete the form (Danisha Montague, 301-504-2129, 15 minutes; Sue Robillard, 612-659-8567, 45 minutes; and Tom Reimler, 612-659-8593, 90 minutes).

FSIS has determined that it will retain its estimate of 90 minutes for completing the form.

9. Payment or Gifts to Respondents:

Respondents will not receive any gifts or payments.

10. Confidentiality Provided to Respondents:

No additional assurance of confidentiality is provided with this information collection. Any and all information obtained in this collection shall not be disclosed except in accordance with 5 U.S.C.552a.

11. Questions of a Sensitive Nature:

The applicants are asked to furnish social security numbers and personal medical information. The information becomes part of the employee Medical Folder, which is maintained and protected in accordance with OPM regulations 5 CFR 293, Subpart E.  These records are also protected by the Privacy Act of 1974, 5 U.S.C. 552a and are covered by OPM/GOVT-10, Employee Medical File System Records.  The social security number is requested in order to more accurately identify and retrieve health care records of individuals.

12. Estimate of Burden

The total burden estimate for the information collection requirements associated with this information collection is 750 hours.

Certificate of Medical Examination

The Agency estimates that 500 individuals will once a year spend 90 minutes to complete a certificate of medical examination for a grand total of 500 responses and 750 burden hours.

CERTIFICATE OF MEDICAL EXAMINATION (FSIS 4339-1)

(5 CFR 339 Medical Qualification Determinations)

Type of Respondent	No. of Respon-dents	No. of Responses per Respondent	Total Annual Responses	Time for Response in Mins.	Total Annual Time in Hours
Individuals	500	1	500	90	750

The cost to the respondents is estimated at $28,500 annually. The Agency estimates that it will cost respondents $38 an hour in fulfilling these information collection requirements. Respondents will spend an annual total of 750 hours and $28,500. The hourly rate for the respondents was attained from the Department of Labor Bureau of Labor and Statistics wage data 2014-2015.

13. Capital and Start-up Cost and Subsequent Maintenance

There are no capital and start-up costs and subsequent maintenance burdens.

14. Annual Cost to Federal Government and Respondents:

The cost to the Federal Government for these information collection requirements is $9,500 annually. The costs arise primarily from the time spent by FSIS staff reviewing protocols and data. The Agency estimates a cost of $38 per hour.

15. Reasons for Changes in Burden:

This is a new information collection consisting of a total of 750 burden hours.

16. Tabulation, Analyses and Publication Plans:

There are no plans to publish the data for statistical use.

17. OMB Approval Number Display:

FSIS will display the OMB approval number on any instructions it publishes relating to recordkeeping activities. The OMB approval number will appear on required FSIS forms.

18. Exceptions to the Certification:

There are no exceptions to the certification. This information collection accords with the certification in item 19 of the OMB 83-I.

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