Medical Clearance Process for Deployment to the Polar Regions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NSF-1429-A Employer Endorsement and Release of Liability	Form	Modified	Available
Form NSF-1428-A Applicant Statement and Release of Liability	Form	Modified	Available
Form NSF-1700 Medical History	Form and Instruction	Modified	Available
Form NSF-1700 Medical Clearance Process for Deployment to the Polar Regions	Form and Instruction	Modified	Repair queued
3145-0177 4-30-2024 Extension.pdf	Supplementary Document	Uploaded 2024-04-12	Repair queued
3145-0177 Supporting Statement 2024.docx	Supporting Statement A	Uploaded 2024-04-12	Repair queued
Presidential Memo 6646.pdf	Supplementary Document	Uploaded 2014-04-28	Repair queued
42 USC 1870.pdf	Supplementary Document	Uploaded 2014-04-28	Repair queued
45cfr675.pdf	Supplementary Document	Uploaded 2007-09-19	Repair queued
privacy act.pdf	Supplementary Document	Uploaded 2007-09-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211404	Medical Clearance Process for Deployment to the Polar Regions	Form	Modified	Employer Endorsement and Release of Liability
211404	Medical Clearance Process for Deployment to the Polar Regions	Form	Modified	Applicant Statement and Release of Liability
211404	Medical Clearance Process for Deployment to the Polar Regions	Form and Instruction	Modified	Medical History
211404	Medical Clearance Process for Deployment to the Polar Regions	Form and Instruction	Modified

ICR Details

OMB Control No: 3145-0177	ICR Reference No: 202404-3145-001
Status: Active	Previous ICR Reference No: 202009-3145-001
Agency/Subagency: NSF	Agency Tracking No:
Title: Medical Clearance Process for Deployment to the Polar Regions
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/15/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/12/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	05/31/2024
Responses	3,700	0	3,650
Time Burden (Hours)	37,000	0	36,500
Cost Burden (Dollars)	1,184,000	0	1,168,000

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Abstract: The National Science Foundation requires all U.S. Antarctic participants and all participants deploying to Greenland and other select regions of the Arctic to take and pass a physical examination prior to deployment. NSF uses the information to determine the medical and dental health and psychological suitability of the polar participants; to determine whether accommodations exist to treat certain ailments and to provide on-site treatment, when needed, without doing harm. The respondents are all USAP participants; all Greenland participants in select regions of the Arctic that are under the auspices of USAP.

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Authorizing Statute(s): US Code: 42 USC 1870 Name of Law: General Authority of Foundation
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 58622	08/28/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 25904	04/12/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medical Clearance Process for Deployment to the Polar Regions	NSF-1429-A, NSF-1700, NSF-1428-A	Medical History ,   Applicant Statement and Release of Liability ,   Employer Endorsement and Release of Liability

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,700	3,650	0	50	0	0
Annual Time Burden (Hours)	37,000	36,500	0	500	0	0
Annual Cost Burden (Dollars)	1,184,000	1,168,000	0	16,000	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The number of applicants to go to the Polar regions has increased; however, the burden time per individual remains the same.

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Annual Cost to Federal Government: $1,425,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/12/2024

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