30-Day FRN

30FRN 1651-0NEW Medical Records Privact Act Release Form.pdf

Hiring Center Medical Records Privacy Release (Form 3400)

30-Day FRN

OMB: 1651-0144

Document [pdf]
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Federal Register / Vol. 87, No. 161 / Monday, August 22, 2022 / Notices

DEPARTMENT OF HOMELAND
SECURITY
U.S. Customs and Border Protection
[1651–0NEW]

CBP Hiring Center Medical Records
Privacy Act Release Form
U.S. Customs and Border
Protection (CBP), Department of
Homeland Security.
ACTION: 30-Day notice and request for
comments; this is a new collection of
information.
AGENCY:

The Department of Homeland
Security, U.S. Customs and Border
Protection will be submitting the
following information collection request
to the Office of Management and Budget
(OMB) for review and approval in
accordance with the Paperwork
Reduction Act of 1995 (PRA). The
information collection is published in
the Federal Register to obtain comments
from the public and affected agencies.
DATES: Comments are encouraged and
must be submitted (no later than
September 21, 2022) to be assured of
consideration.
ADDRESSES: Written comments and/or
suggestions regarding the item(s)
contained in this notice should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
FOR FURTHER INFORMATION CONTACT:
Requests for additional PRA information
should be directed to Seth Renkema,
Chief, Economic Impact Analysis
Branch, U.S. Customs and Border
Protection, Office of Trade, Regulations
and Rulings, 90 K Street NE, 10th Floor,
Washington, DC 20229–1177, telephone
number 202–325–0056 or via email
[email protected]. Please note that
the contact information provided here is
solely for questions regarding this
notice. Individuals seeking information
about other CBP programs should
contact the CBP National Customer
Service Center at 877–227–5511, (TTY)
1–800–877–8339, or CBP website at
https://www.cbp.
gov/.
SUPPLEMENTARY INFORMATION: CBP
invites the general public and other
Federal agencies to comment on the
proposed and/or continuing information
collections pursuant to the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501
et seq.). This proposed information
collection was previously published in

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the Federal Register (Volume 87 FR
14902) on March 16, 2022, allowing for
a 60-day comment period. This notice
allows for an additional 30 days for
public comments. This process is
conducted in accordance with 5 CFR
1320.8. Written comments and
suggestions from the public and affected
agencies should address one or more of
the following four points: (1) whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information will have
practical utility; (2) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used; (3)
suggestions to enhance the quality,
utility, and clarity of the information to
be collected; and (4) suggestions to
minimize the burden of the collection of
information on those who are to
respond, including through the use of
appropriate automated, electronic,
mechanical, or other technological
collection techniques or other forms of
information technology, e.g., permitting
electronic submission of responses. The
comments that are submitted will be
summarized and included in the request
for approval. All comments will become
a matter of public record.
Overview of This Information
Collection
Title: CBP Hiring Center Medical
Records Privacy Act Release Form.
OMB Number: 1651–0NEW.
Form Number: Form 3400.
Current Actions: This is a new
information collection.
Type of Review: New.
Affected Public: Individuals.
Abstract: In accordance with 5 CFR
339.301, Customs and Border Protection
(CBP) performs pre-employment
medical evaluations on all candidates
tentatively selected to fill positions that
include a medical requirement, such as
the CBP Officer and Border Patrol Agent
positions. During that evaluation
process, CBP collects medically relevant
information about the candidate from:
the candidate, CBP’s contracted medical
providers, and/or the candidate’s
personal medical and mental health
providers.
In accordance with 5 CFR 339.305,
CBP makes all medical documentation
and records of examination available to
the candidates. Candidates can request
copies of their pre-employment medical
examination results and supporting
documentation/records by email or
letter. Due to the sensitive nature of the
information being released, CBP
requires that candidates complete and

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sign a privacy release authorization
form in order to receive a copy of their
medical documents. CBP will only share
medical information directly with the
candidate, or with a third party when
authorized to do so in writing by the
candidate.
No specific information is needed to
request copies of candidates’ medical
documents in writing. When completing
the release form, candidates must
provide the following information: Full
name, partial Social Security Number
(SSN#), Date of Birth, Current Address,
Email Address, Phone Number; as well
as specifying the type of medical
records to be released (hearing test
results, vision test results, etc.).
This information is used by CBP as
confirmation that the agency has the
candidate’s signed authorization to
provide medically related records about
the candidate. A copy of that signed
authorization and the records released
are retained within the candidate’s preemployment file.
Type of Information Collection:
Medical Records Privacy Act Release
Form.
Estimated Number of Respondents:
104.
Estimated Number of Annual
Responses per Respondent: 2.
Estimated Number of Total Annual
Responses: 208.
Estimated Time per Response: 15
minutes.
Estimated Total Annual Burden
Hours: 52 hours.
Dated: August 16, 2022.
Seth D. Renkema,
Branch Chief, Economic Impact Analysis
Branch, U.S. Customs and Border Protection.
[FR Doc. 2022–17954 Filed 8–19–22; 8:45 am]
BILLING CODE 9111–14–P

DEPARTMENT OF THE INTERIOR
Fish and Wildlife Service
[Docket No. FWS–HQ–IA–2022–0064;
FXIA16710900000–223–FF09A30000]

Endangered Species; Marine
Mammals; Issuance of Permits
Fish and Wildlife Service,
Interior.
ACTION: Notice of issuance of permits.
AGENCY:

We, the U.S. Fish and
Wildlife Service (Service), have issued
the following permits to conduct certain
activities with endangered species and
marine mammals. We issue these
permits under the Endangered Species
Act (ESA) and Marine Mammal
Protection Act (MMPA).

SUMMARY:

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File Modified2022-08-20
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