Pursuant to 22 U.S.C. § 4084, the Secretary of State has the authority to establish a Medical Program. This information collection provides to the U.S. Department of Stateâs Office of Medical Services the information needed to determine whether a candidate for a Foreign Service appointment is able to obtain the medical clearance required for that appointment, and to determine the appropriate medical clearances for other individuals who participate in the Medical Program. The information is requested pursuant to the Foreign Service Act of 1980, as amended, in particular 22 U.S.C. §§ 4084, 3901, and 3984. Revisions to the forms are needed to clarify that the information collection is consistent with applicable authorities, including 42 U.S.C. § 2000ff, Title II, and 29 C.F.R. Part 1635.
These forms require a pre-assignment and pre-employment applicant, and their eligible family members, to provide information regarding chronic medical conditions, mental health status, and past mental health treatment. Although not routinely discussed, except with a personâs health care provider, these questions are necessary to gauge the individual and family membersâ ability to be assigned to hardship posts, or posts where medical resources are scarce. These forms also might include information regarding special educational needs that a dependent child may have.
$30,748
No
Yes
Yes
No
No
No
No
Claire Whitacre 771 205-9036
Reginfo record details
No
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:
(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;
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.
Form DS-1843 MEDICAL HISTORY AND EXAMINATION FOR INDIVIDUALS AGE 12 AND OLDER
fy-2025-2029-strategic-plan_508_0.pdf
Poole_Obelisk_Enforcement_Architecture_April2026.docx
Medical History and Examination