Information Collection

Medical Clearance Process for Deployment to the Polar Regions

IC 211404 under ICR 202009-3145-001 · OMB 3145-0177.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3145-0177 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NSF 1700 Medical Clearance Process for Deployment to the Polar Regions	Form and Instruction
NSF 1700 Polar Medical Forms NSF 2017 PLR Med forms rev May 2017_v5.pdf	Form and Instruction
Participation Letter.docx Polar Participation Letter	IC Document
PQEmail-ASC_v2.docx Polar Physical Qualification letter	IC Document
3145-0177 Mandatory Reading.pdf OPP Mandatory Reading for Polar Medical forms	IC Document

IC Title:

Medical Clearance Process for Deployment to the Polar Regions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NSF 1700	Polar Medical Forms	NSF 2017 PLR Med forms rev May 2017_v5.pdf		Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,650

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,650	3,650
Annual IC Time Burden (Hours)	36,500	36,500
Annual IC Cost Burden (Dollars)	1,168,000	1,168,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Polar Participation Letter	Participation Letter.docx	06/23/2017
Polar Physical Qualification letter	PQEmail-ASC_v2.docx	06/23/2017
OPP Mandatory Reading for Polar Medical forms	3145-0177 Mandatory Reading.pdf	06/23/2017

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