OPM Gov't -10 SORN

OPM GOVT-10 SORN.pdf

Request for a Medical or Religious Exception or Delay to the COVID-19 Vaccination Requirement

OPM Gov't -10 SORN

OMB: 1225-0092

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OPM/GOVT–10
SYSTEM NAME:
Employee Medical File System Records.
SYSTEM LOCATION:
a. For current employees, records are located in agency medical, personnel, dispensary, health, safety, or
other designated offices within the agency, or contractors performing a medical function for the agency.
b. For former employees, most records will be located in an Employee Medical Folder (EMF) stored at the
National Personnel Records Center operated by the National Archives and Records Administration (NARA). In
some cases, agencies may retain for a limited time (e.g., up to 3 years) some records on former employees.
Note 1:
The records in this system of records are “owned” by the Office of Personnel Management (OPM) and should
be provided to those OPM employees who have an official need or use for those records. Therefore, if an
employing agency is asked by an OPM employee to access the records within this system, such a request
should be honored.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Current and former Federal civilian employees as defined in 5 U.S.C. 2105.
CATEGORIES OF RECORDS IN THE SYSTEM:
Records maintained in this system include:
a. Medical records, forms, and reports completed or obtained when an individual applies for a Federal job and
is subsequently employed;
b. Medical records, forms, and reports completed during employment as a condition of employment, either by
the employing agency or by another agency, State or local government entity, or a private sector entity under
contract to the employing agency;
c. Records pertaining and resulting from the testing of the employee for use of illegal drugs under Executive
Order 12564. Such records may be retained by the agency (e.g., by the agency Medical Review Official) or by

a contractor laboratory. This includes records of negative results, confirmed or unconfirmed positive test
results, and documents related to the reasons for testing or other aspects of test results.
d. Reports of on-the-job injuries and medical records, forms, and reports generated as a result of the filing of a
claim for Workers' Compensation, whether the claim is accepted or not. (The official compensation claim file is
not covered by this system; rather, it is part of the Department of Labor's Office of Workers' Compensation
Program (OWCP) system of records.)
e. All other medical records, forms, and reports created on an employee during his/her period of employment,
including any retained on a temporary basis (e.g., those designated to be retained only during the period of
service with a given agency) and those designated for long-term retention (i.e., those retained for the entire
duration of Federal service and for some period of time after).
f. Records resulting from participation in agency-sponsored health promotion and wellness activities, including
health risk appraisals, biometric testing, health coaching, disease management, behavioral management,
preventive services, fitness programs, and any other activities that could be considered part of a
comprehensive worksite health and wellness program.
Note 2:
Records maintained by an agency dispensary are included in this system only when they are the result of a
condition of employment or related to an on-the-job occurrence or result from participation in an agencysponsored health and wellness program.
Note 3:
Records pertaining to employee drug or alcohol abuse counseling or treatment, and those pertaining to other
employee counseling programs conducted under the Health Service Program established pursuant to 5 U.S.C.
chapter 79, are not part of this system of records.
Note 4:
Only Routine Use “u” identified for this system of records is applicable to records relating to drug testing under
Executive Order 12564. Further, such records shall be disclosed only to a very limited number of officials within
the agency, generally only to the agency Medical Review Official (MRO), the administrator of the agency
Employee Assistance Program, and any supervisory or management official within the employee's agency
having authority to take the adverse personnel action against the employee.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Executive Orders 12107, 12196, and 12564 and 5 U.S.C. chapters 11, 33, and 63.
PURPOSE(S):
Records in this system of records are maintained for a variety of purposes, which include the following:
a. To ensure that records required to be retained on a long-term basis to meet the mandates of law, Executive
Order, or regulations (e.g., the Department of Labor's Occupational Safety and Health Administration (OSHA)
and OWCP regulations), are so maintained.
b. To provide data necessary for proper medical evaluations and diagnoses, to ensure that proper treatment is
administered, and to maintain continuity of medical care.
c. To provide an accurate medical history of the total health care and medical treatment received by the
individual as well as job and/or hazard exposure documentation and health monitoring in relation to health
status and claims of the individual.
d. To enable the planning for further care of the patient.
e. To provide a record of communications among members of the health care team who contribute to the
patient's care.
f. To provide a legal document describing the health care administered and any exposure incident.
g. To provide a method for evaluating quality of health care rendered and job-health-protection including
engineering protection provided, protective equipment worn, workplace monitoring, and medical exam
monitoring required by OSHA or by good practice.
h. To ensure that all relevant, necessary, accurate, and timely data are available to support any medicallyrelated employment decisions affecting the subject of the records (e.g., in connection with fitness-for-duty and
disability retirement decisions).
i. To document claims filed with and the decisions reached by the OWCP and the individual's possible
reemployment rights under statutes governing that program.

j. To document employee's reporting of on-the-job injuries or unhealthy or unsafe working conditions, including
the reporting of such conditions to OSHA and actions taken by that agency or by the employing agency.
k. To ensure proper and accurate operation of the agency's employee drug testing program under Executive
Order 12564.
l. To facilitate communication among members of an on-site health and wellness program and to the individual
employee participating in the program.
m. To enable evaluation of the effectiveness of on-site health and wellness programs.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS
AND THE PURPOSE OF SUCH USES:
Note 5:
With the exception of Routine Use “u,” none of the other Routine Uses identified for this system of records are
applicable to records relating to drug testing under Executive Order 12564. Further, such records shall be
disclosed only to a very limited number of officials within the agency, generally only to the agency Medical
Review Official (MRO), the administrator of the agency Employee Assistance Program, and the management
official empowered to recommend or take adverse action affecting the individual. These records and
information in these records may be used:
a. To disclose information to the Department of Labor, Department of Veterans Affairs, Social Security
Administration, Federal Retirement Thrift Investment Board, or a national, State, or local social security type
agency, when necessary to adjudicate a claim (filed by or on behalf of the individual) under a retirement,
insurance, or health benefit program.
b. To disclose information to a Federal, State, or local agency to the extent necessary to comply with laws
governing reporting of communicable disease.
c. To disclose information to another Federal agency, to a court, or a party in litigation before a court or in an
administrative proceeding being conducted by a Federal agency when the Government is a party to the judicial
or administrative proceeding.
d. To disclose information to the Department of Justice, or in a proceeding before a court, adjudicative body,
other administrative body before which the agency is authorized to appear, when:

1. The agency, or any component thereof; or
2. Any employee of the agency in his or her official capacity; or
3. Any employee of the agency in his or her individual capacity where the Department of Justice or the agency
has agreed to represent the employee; or
4. The United States, where the agency determines that litigation is likely to affect the agency or any of its
components, is a party to litigation or has an interest in such litigation, and the use of such records by the
Department of Justice or the agency is deemed by the agency to be relevant and necessary to the litigation,
provided, however, that in each case it has been determined that the disclosure is compatible with the purpose
for which the records were collected.
e. To disclose in response to a request for discovery or for appearance of a witness, information that is relevant
to the subject matter involved in a pending judicial or administrative proceeding.
f. To disclose pertinent information to the appropriate Federal, State, or local agency responsible for
investigating, prosecuting, enforcing, or implementing a statute, rule, regulation, or order when the disclosing
agency becomes aware of an indication of a violation or potential violation of civil or criminal law or regulation.
g. To disclose information to the Office of Management and Budget at any stage in the legislative coordination
and clearance process in connection with private relief legislation as set forth in OMB Circular No. A–19.
h. To disclose information to a congressional office from the record of an individual in response to an inquiry
from the congressional office made at the request of that individual.
i. To disclose information to the Merit System Protection Board or the Office of the Special Counsel, the
Federal Labor Relations Authority and its General Counsel, the Equal Employment Opportunity Commission,
arbitrators, and hearing examiners to the extent necessary to carry out their authorized duties.
j. To disclose information to survey team members from the Joint Commission on Accreditation of Hospitals
(JCAH) when requested in connection with an accreditation review, but only to the extent that the information is
relevant and necessary to meet the JCAH standards.
k. To disclose information to the National Archives and Records Administration in records management
inspections and its role as Archivist.

l. To disclose information to health insurance carriers contracting with the Office to provide a health benefits
plan under the Federal Employees Health Benefits Program information necessary to verify eligibility for
payment of a claim for health benefits.
m. By the agency maintaining or responsible for generating the records (or third parties under contract with the
agency) to locate individuals for health research or survey response and in the production of summary
descriptive statistics and analytical studies (e.g., epidemiological studies) in support of the function for which
the records are collected and maintained. While published statistics and studies do not contain individual
identifiers, in some instances the selection of elements of data included in the study might be structured in such
a way as to make the data individually identifiable by inference.
n. To disclose information to the Office of Federal Employees Group Life Insurance or Federal Retirement Thrift
Investment Board that is relevant and necessary to adjudicate claims.
o. To disclose information, when an individual to whom a record pertains is mentally incompetent or under
other legal disability, to any person who is responsible for the care of the individual, to the extent necessary.
p. To disclose to the agency-appointed representative of an employee, all notices, determinations, decisions, or
other written communications issued to the employee, in connection with an examination ordered by the
agency under medical evaluation (formerly Fitness for Duty) examinations procedures.
q. To disclose to a requesting agency, organization, or individual the home address and other information
concerning those individuals who it is reasonably believed might have contracted an illness or been exposed to
or suffered from a health hazard while employed in the Federal workforce.
r. To disclose information to a Federal agency, in response to its request or at the initiation of the agency
maintaining the records, in connection with the retention of an employee, the issuance of a security clearance,
the conducting of a suitability or security investigation of an individual, the classifying of jobs, the letting of a
contract, or the issuance of a license, grant, or other benefit by the requesting agency, or the lawful, statutory,
administrative, or investigative purpose of the agency, to the extent that the information is relevant and
necessary to the requesting agency's decision on the matter.
s. To disclose to any Federal, State, or local government agency, in response to its request or at the initiation of
the agency maintaining the records, information relevant and necessary to the lawful, statutory, administrative,
or investigatory purpose of that agency as it relates to the conduct of job related epidemiological research or
the assurance of compliance with Federal, State, or local government laws on health and safety in the work
environment.

t. To disclose to officials of labor organizations recognized under 5 U.S.C. chapter 71, analyses using exposure
or medical records and employee exposure records, in accordance with the records access rules of the
Department of Labor's OSHA, and subject to the limitations at 29 CFR 1910.20(e)(2)(iii)(B).
u. To disclose the results of a drug test of a Federal employee pursuant to an order of a court of competent
jurisdiction where required by the United States Government to defend against any challenge against any
adverse personnel action.
v. To disclose information to contractors, grantees, or volunteers performing or working on a contract, service,
grant, cooperative agreement or job for the Federal Government.
w. To disclose records on former Panama Canal Commission employees to the Republic of Panama for use in
employment matters.
x. To evaluate and report on the effectiveness of health and wellness programs by agency staff or third parties
under contract with the agency to conduct such evaluations.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, SAFEGUARDING, AND RETAINING AND
DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Records are stored in file folders, on microfiche, in electronic record systems, and on file cards, x-rays, or other
medical reports and forms.
RETRIEVABILITY:
Records are retrieved by the employee's name, date of birth, social security number, or any combination of
those identifiers.
SAFEGUARDS:
Records are stored in locked file cabinets or locked rooms. Electronic records are protected by restricted
access procedures and audit trails. Access to records is strictly limited to agency or contractor officials with a
bona fide need for the records.
RETENTION AND DISPOSAL:

The EMF is maintained for the period of the employee's service in the agency and is then transferred to the
National Personnel Records Center for storage, or as appropriate, to the next employing Federal agency. Other
medical records are either retained at the agency for various lengths of time in accordance with the National
Archives and Records Administration's records schedules or destroyed when they have served their purpose or
when the employee leaves the agency. Within 90 days after the individual separates from the Federal service,
the EMF is sent to the National Personnel Records Center for storage. Destruction of the EMF is in accordance
with General Records Schedule-1(21). Records arising in connection with employee drug testing under
Executive Order 12564 are generally retained for up to 3 years. Records are destroyed by shredding, burning,
or by erasing the disk.
SYSTEM MANAGER(S) AND ADDRESS:
a. Group Manager, Employee Services, Resources Management Group, 1900 E Street, NW., Room 7305,
Washington, DC 20415.
b. For current Federal employees, OPM has delegated to the employing agency the Privacy Act responsibilities
concerning access, amendment, and disclosure of the records within this system notice.
NOTIFICATION PROCEDURE:
Individuals wishing to inquire whether this system of records contains records on them should follow the
appropriate procedure listed below.
a. Current Employees. Current employees should contact their employing agency's personnel, dispensary,
health, safety, medical, or other designated office responsible for maintaining the records, as identified in the
agency's internal issuance covering this system. Individuals must furnish such identifying information as
required by the agency for their records to be located and identified.
b. Former employees. Former employees should contact their former agency's personnel, dispensary, health,
safety, medical, or other designated office responsible for maintaining the records, as identified in the agency's
internal issuance covering this system.
Additionally, for access to their EMF, they should submit a request to the National Personnel Records Center
(Civilian), 111 Winnebago Street, St. Louis, Missouri 63118.
RECORDS ACCESS PROCEDURE:

a. Current employees should contact the appropriate agency office as indicated in the Notification Procedure
section and furnish such identifying information as required by the agency to locate and identify the records
sought.
b. Former employees should contact the appropriate agency office as indicated in the Notification Procedure
section and furnish such identifying information as required by the agency to locate and identify the records
sought. Former employees may also submit a request to the National Personnel Records Center (Civilian), 111
Winnebago Street, St. Louis, Missouri 63118, for access to their EMF. When submitting a request to the
National Personnel Records Center, the individual must furnish the following information to locate and identify
the record sought:
1. Full name.
2. Date of birth.
3. Social security number.
4. Agency name, date, and location of last Federal service.
5. Signature.
c. Individuals requesting access must also comply with OPM's Privacy Act regulations on verification of identity
and access to records (5 CFR part 297).
CONTESTING RECORDS PROCEDURE:
Because medical practitioners often provide differing, but equally valid medical judgments and opinions when
making medical evaluations of an individual's health status, review of requests from individuals seeking
amendment of their medical records, beyond correction and updating of the records, will be limited to
consideration of including the differing opinion in the record rather than attempting to determine whether the
original opinion is accurate. Individuals wishing to amend their records should:
a. For a current employee, contact the appropriate agency office identified in the Notification Procedure section
and furnish such identifying information as required by the agency to locate and identify the records to be
amended.
b. For a former employee, contact the appropriate agency office identified in the Notification Procedure section
and furnish such identifying information as required by the agency to locate and identify the record to be

amended. Former employees may also submit a request to amend records in their EMF to the system
manager. When submitting a request to the system manager, the individual must furnish the following
information to locate and identify the records to be amended:
1. Full name.
2. Date of birth.
3. Social security number.
4. Agency name, date, and location of last Federal service.
5. Signature.
c. Individuals seeking amendment of their records must also follow the Office's Privacy Act regulations on
verification of identity and amendment of records (5 CFR part 297).
RECORDS SOURCE CATEGORIES:
RECORDS IN THIS SYSTEM ARE OBTAINED FROM:
a. The individual to whom the records pertain.
b. Agency employee health unit staff.
c. Federal and private sector medical practitioners and treatment facilities.
d. Supervisors/managers and other agency officials.
e. Other agency records.


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File Modified0000-00-00
File Created2021-11-12

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