The Peace Corps Office of Medical
Services is responsible for the collection of applicant dental
information, using the Report of Dental Exam form. The Dental Exam
form is completed by the applicant and the applicant's examining
dentist. The results of the examinations are used to ensure that
applicants for Volunteer service will, with reasonable
accommodation, be able to serve in the Peace Corps without
jeopardizing their health.
The Peace Corps is upgrading the medical
component of the electronic application process as part of a larger
quality improvement project. In conjunction with this project,
medical staff have reviewed and revised the medical screening forms
including the Health History Form, The Report of Physical
Examination, Report of Dental Examination, and the Individual
Specific Medical Evaluation Forms. These changes are being made in
an effort to: • Reduce the time required for an Applicant and their
health care providers to manage and complete the medical forms •
Reduce the number of medical forms • Clarify content based on the
lessons learned from customer feedback Applicants access the Dental
Examination form via a secure online portal. Applicants will
download the form for their dentist to complete. The Dental Exam
form must be personally completed and signed by the examining
dentist. The completed form can be scanned and uploaded into the
Applicant’s secure Peace Corps online portal, faxed, or mailed to
the Peace Corps Office of Medical Services.
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
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.