Medical history, which is provided by
completing the Health Screening Questionaire, Medical
Qualifications Program Medical Exam and Self-Certification
Statement supplies information needed to determine certification of
suitability, any special medical or medication needs, and a file
record to protect both the Federal Government and
individuals.
US Code:
16
USC 594 Name of Law: The Protection Act of 1922
The program change increase is
for two new forms, FS-5100-32 and FS-5100-33. The adjustment
increase covers an increase in respondents and an increase in the
number of medical qualification exams done annually for safety
reasons.
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.