Fire and Aviation Medical Management Qualifications Program

Fire and Aviation Management Medical Qualifications Program

OMB: 0596-0164

IC ID: 43556

Information Collection (IC) Details

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Fire and Aviation Medical Management Qualifications Program
 
No Modified
 
Required to Obtain or Retain Benefits
 
5 CFR 339

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FS-5100-31 Health Screening Questionnaire FS-5100-31 Rev corrected version JS_2.docx http://www.fs.fed.us/fire/safety/wct/wct_index.html Yes No Fillable Printable
Form FS 5100-30 Work Capacity Test - Informed Consent FS-5100-30_v032016.docx http://www.fs.fed.us/fire/safety/wct/wct_index.html Yes Yes Fillable Printable
Form FS-5100-41 USFS Wildland Firefighter Medical Qualifications Program Physical Exam FS-5100-41 corrected version JS.docx Yes No Fillable Printable
Form FS-5100-42 Self Certification Statement and Blood Pressure Check FS-5100-42_v032016.docx Yes No Fillable Printable

Disaster Management Emergency Response

Privacy Act System of Records OPM/Govt-10 Employee Medical File Sys Records  65 FR 24732

89,778 0
   
Individuals or Households
 
   60 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 89,778 0 258 0 0 89,520
Annual IC Time Burden (Hours) 10,488 0 199 0 0 10,289
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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