Justification for changes

Health History Form

OMB Control Number 0420-0510

Justification for No Material/Nonsubstantive Change

The Peace Corps Office of Health Services proposes to make changes to the Peace Corps Health History Form, OMB Control Number: 0420-0510, submitted for OMB approval on 12/20/2016.

The changes are intended to clarify and simplify the applicant health history questions as well as reduced the number of associated questions. The reduced number of associated questions is based on the recognition that the new Transfer of Care – Request for Information Form will provide the diagnosis, current treatment, physical limitations and will provide the basis for an individualized determination as to whether the Applicant will, with reasonable accommodation, be able to perform the essential functions of a Peace Corps Volunteer assignment and complete a tour of service without unreasonable disruption due to health problems. This form will also be used to determine the type of accommodation (e.g., avoidance of high altitudes or proximity to a hospital) that may be needed to manage the Applicant’s medical condition.

Matching changes have been made to each body system for consistency and reliability. See attached document. The changes present no material and no substantive changes and serve to clarify and simplify questions. There will be no change to burden. The changes are non-substantive and, as a result, do not require approval under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq.

This revised Health History Form and Durable Medical Equipment and other Devices Form, which replaces the Health History Form and Durable Medical Equipment and other Devices Form currently under review, will result in most Applicants answering significantly fewer questions than they would with the current Health History Form.