Certificate of Medical Examination

ICR 202001-0583-003

OMB: 0583-0167

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2020-01-10
Supporting Statement A
2019-10-15
IC Document Collections
IC ID
Document
Title
Status
218023 Modified
ICR Details
0583-0167 202001-0583-003
Historical Active 201910-0583-001
USDA/FSIS
Certificate of Medical Examination
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/16/2020
Retrieve Notice of Action (NOA) 01/13/2020
  Inventory as of this Action Requested Previously Approved
11/30/2022 11/30/2022 11/30/2022
800 0 800
809 0 809
0 0 0

to collect certificates of medical examination 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 and to collection information for requests for reasonable accommodations and the leave bank program.

US Code: 21 USC 1031 Name of Law: Egg Products Inspection Act
   US Code: 21 USC 601 Name of Law: Federal Meat Inspection Act
   US Code: 21 USC 451 Name of Law: Poultry Products Inspection Act
  
None

Not associated with rulemaking

  84 FR 32704 07/09/2019
84 FR 55902 10/18/2019
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 800 800 0 0 0 0
Annual Time Burden (Hours) 809 809 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$18,344
No
    Yes
    Yes
No
No
No
Uncollected
Gina Kouba 202 690-6510 [email protected]

  No

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.
01/13/2020


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