Information Collection

Medical Clearance Update

IC 264603 under ICR 202503-1405-004 · OMB 1405-0131.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-3057 Medical Clearance Update	Form and Instruction
Form DS-3057 Medical Clearance Update Medical Clearance Update	Form and Instruction
DS-3057 Medical Clearance Update ds3057 - DRAFT - 03-18-2025.pdf	Form and Instruction
DS-3057 Medical Clearance Update ds3057 - DRAFT - 03-18-2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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				No		Paper Only

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
	Approved	Previously Approved
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.

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