Report of Medical History - Annual Update

NOAA Diving Program

Documents and Forms

Document Name Document Type
Form NF 57-03-54 Report of Medical History - Annual Update Form and Instruction
NF 57-03-54 Report of Medical History - Annual Update NF 57-03-54 Report of Medical History - Annual.pdf Form and Instruction
NF 57-03-54 Report of Medical History - Annual Update NF 57-03-54 Report of Medical History - Annual.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Report of Medical History - Annual Update	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 57-03-54	Report of Medical History - Annual Update	NF 57-03-54 Report of Medical History - Annual.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: 143	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	143	143
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

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.