Fire and Aviation Medical Management Qualifications Program

Fire and Aviation Management Medical Qualifications Program

OMB: 0596-0164

IC ID: 43556

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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-5100-30 Informed Consent FS-5100-30 exp2025.docx Yes No Fillable Printable
Form FS-5100-31 Health Screening Questionnaire FS-5100-31 exp 2025.docx Yes No Fillable Printable
Form FS-5100-41 Essential Function & Work Conditions FS-5100-41 exp2025.docx Yes No Fillable Printable
Form FS-5100-42 Self Certification Statement FS-5100-42 exp2025.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

61,000 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 61,000 0 -28,778 0 0 89,778
Annual IC Time Burden (Hours) 20,587 0 10,099 0 0 10,488
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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