Report of Physical Examination

NOAA Diving Program

Documents and Forms

Document Name Document Type
Form NF 57-03-52 Report of Physical Examination - Diver Form and Instruction
NF 57-03-52 Report of Examination and Medical History - Diver NF 57-03-52 Report of Examination and Medical History - Diver.pdf Form and Instruction
NF 57-03-52 Report of Examination and Medical History - Diver NF 57-03-52 Report of Examination and Medical History - Diver.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Report of Physical Examination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NF 57-03-52	Report of Examination and Medical History - Diver	NF 57-03-52 Report of Examination and Medical History - Diver.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: COMMERCE/NOAA-10 NOAA Diving Program File.	FR Citation: 72 FR 45009

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	11,700	11,700

Documents for IC

Title	Document	Date Uploaded
No associated records found

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