Information Collection

Medical Clearance Update

IC 263839 under ICR 202312-1405-002 · OMB 1405-0131.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0131 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-3057 Medical Clearance Update	Form and Instruction
DS-3057 Medical Clearance Update DS5 - 3057 9-7-2023.pdf	Form and Instruction
DS-3057 Medical Clearance Update DS5 - 3057 9-7-2023.pdf	Form and Instruction

IC Title:

Medical Clearance Update

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-3057	Medical Clearance Update	DS5 - 3057 9-7-2023.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medical Clearance Update

FR Citation: 88 FR 67857

Number of Respondents: 8,782

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,782	8,782
Annual IC Time Burden (Hours)	4,391	4,391
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.