Pre-Employment Medical and Driver Medical Evaluation Forms

Pre-Employment Medical and Driver Medical Evaluation Forms

OMB:

IC ID: 270045

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Pre-Employment Medical and Driver Medical Evaluation Forms
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DS-6571 Med Eval for LES non-drivers ds6571 - DRAFT - 03-20-2024.pdf No   Paper Only
Form and Instruction DS-6572 Driver Medical Eval for LES ds6572 - DRAFT - 04-10-2024.pdf No   Paper Only
Form and Instruction DS-6573 TB Risk Assessment ds6573 - DRAFT - 03-21-2024.pdf No   Paper Only
Form and Instruction DS-6574 Seizure/Epilepsy ds6574 - DRAFT - 03-20-2024.pdf No   Paper Only
Form and Instruction DS-6575 Diabetes ds6575 - DRAFT - 03-20-2024.pdf No   Paper Only
Form and Instruction DS-6576 USDH Driver ds6576 - DRAFT - 03-20-2024.pdf No   Paper Only
Form and Instruction DS-6577 Vision Assessment ds6577 - DRAFT - 03-20-2024.pdf No   Paper Only

Health Health Care Services

Pre-Employment Medical and Driver Medical Evaluation Forms  89 FR 45726

13,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 13,000 0 13,000 0 0 0
Annual IC Time Burden (Hours) 34,550 0 34,550 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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