TEMPLATE/GUIDELINES FOR PREPARING THE SUPPORTING STATEMENT

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SUPPORTING STATEMENT PART A

National Aeronautics and Space Administration
JSC Form 1830 – Report of Medical Examination
OMB Control No. 2700-0170

Type of Information Collection: Revision of a currently approved collection.

Abstract: The Neutral Buoyancy Laboratory (NBL) at the National Aeronautics and Space Administration (NASA) Johnson Space Center (JSC) provides astronauts with training for future on-orbit procedures, including extravehicular activities. NASA also permits non-NASA guest divers to participate in the NBL diving experience. Guest divers must present a dive physical examination from a certified Diving Medical Examiner. Results are documented on the JSC Form 1830 Report of Medical Examination and reviewed by the NBL Dive Physician prior to participation.

Summary of Changes from Previously Approved Collection: 
    • Updated Privacy Act and Paperwork Reduction Act Statements.
    • Annual respondent cost decreased from $2,250 to $1,350 due to correction of a miscalculation in the previously submitted burden cost estimate.

    1. Need for the Information Collection. 
NASA’s NBL has used neutral buoyancy since the mid-1960s to simulate reduced gravity for astronaut training and hardware testing. This allows astronauts to practice extravehicular activities (EVA) and solve on-orbit problems in realistic conditions.

NASA hires individuals with demonstrated diving experience as NBL Working Divers in teams comprised of four divers: two safety divers, one utility diver, and one cameraman to assist astronauts. Non-NASA guest divers, typically media representatives, are permitted to participate if they provide a recent dive physical examination from a certified Diving Medical Examiner. Those who do not have a current U.S. Navy, Association of Diving Contractors (ADC), or Medical Examination of Divers (MA1) British standard for commercial diving physical are required to complete a medical examination. The results are documented on JSC Form 1830 and reviewed by the NBL Dive Physician before participation. The cost for guest divers’ medical exams depends on their insurance.

    2. Purpose and Use of the Information Collection. 
A non‑NASA guest diver must submit a completed dive physical (U.S. Navy, ADC, MA1, or JSC Form 1830 Report of Medical Examination, with all applicable test results attached). This documentation is used by NASA physicians and clinic staff to confirm safety and eligibility for NBL diving activities. The diver may provide the completed physical digitally through an encrypted email link or hand‑carry it with any supporting medical documentation; hand‑carried records are scanned into an encrypted folder and then sent electronically to the JSC Clinic, while digitally submitted records are forwarded directly. The clinic creates an electronic medical record for physician review and qualification. 
    3. Use of Information Technology. 
NBL support personnel provide non‑NASA guest divers with a secure email link granting access to the JSC Clinic Online Portal, which is used to electronically collect all required medical information. In addition to portal submission, the dive‑physical form may be provided directly to the diver or sent as a digital PDF version via email. After the diver’s primary care provider completes the form, the diver returns it either through the secure portal or by submitting the completed PDF electronically. These methods ensure secure transmission for the handling of medical documentation.

    4. Duplication of Information. 
There is no duplication as there are no other sources available to collect this information.

    5. Burden on Small Businesses.
The collection of information does not affect small businesses or other small entities.

    6. Consequences of Not Conducting the Collection.
If a diver’s physical examination cannot be verified, non-NASA guest diving activities will not be permitted.

    7. Special Circumstances.
      All data will be collected in a manner consistent with the guidelines in 5 CFR 1320.6.

    8. Consultations with Persons Outside the Agency and Public Comments.
      A 60-day Federal Register Notice (FRN): 91 FR 33235, was published on 06/3/2026. 
      No comments were received.
      
      A 30-day FRN: 91 FR 54889, was published on 8/25/2026.

    9. Payment or Gifts.  
No payments or gifts are being offered to respondents. 

    10. Confidentiality Provided to Respondents. 
 NASA does not provide any assurance of confidentiality; however, information is handled consistently with the Privacy Act of 1974, and in accordance with NASA’s Privacy and Information Security policies. Access is limited to authorized personnel, and electronic submissions use secure, encrypted transmission. A Privacy Impact Assessment has been completed, and records are maintained under System of Records Notice NASA 10HIMS—Health Information Management System (found online at: https://www.federalregister.gov/documents/2023/10/10/2023-22412/privacy-act-of-1974-system-of-records).
Forms are retained in accordance with NASA Records Retention Schedules (NRRS 08/109.0 Program and Project Records (found online at: https://nodis3.gsfc.nasa.gov/NPR_attachments/NRRS_1441.1_09032025.pdf).


    11. Questions of Sensitive Nature.
Questions regarding a potential applicant’s medical history are required for participation.

    12. Burden of Information Collection.
The table below summarizes the estimates of the hour burden of the collection of information. 

Category of Respondents
Annual Number of Responses
Estimated Time per Response  
Total Annual Burden Hours
Participants 
(Guest Divers)
30
90 minutes
45


    13. Annual Cost to Respondents.
Respondent wage is estimated at $30 per hour. Each response requires 90 minutes (1.5 hours), resulting in a cost of $45 per respondent. With 30 respondents annually, the total annual cost to respondents is $45 × 30 = $1,350.

    14. Annualized Cost to the Federal Government. 
The estimated annualized cost to the Federal Government for reviewing reports under this information collection is $2,707.35. This amount reflects one hour of review time for each of the 30 annual reports. The calculation includes labor costs for a NASA Contract Technician and a NASA Contractor Medical Officer, as shown in the table below.

Task
Rate of pay/hour
Percent of time
Total hours
Total
NASA Contract Technician
$ 50.49
1%
15
$    757.35
NASA Contractor Medical Officer
$130.00
1%
15
$    1,950
Total for projects/year



$ 2,707.35

    15. Changes in Burden.  
Although the burden hours did not change, a calculation error in the prior submission resulted in an incorrect annual respondent cost. This updated Supporting Statement corrects that error and now reflects the accurate total annual respondent cost based on the proper number of respondents and time per response.

    16. Publication of Results.  
There will be no publication from this collection NASA will not publish results from this information collection.

    17. Display of OMB Approval.
NASA displays an approved Paperwork Reduction Act Statement, OMB control Number and expiration date for this collection. 

    18. Exceptions to Certification for Paperwork Reduction Act Submissions.
      There are no exceptions to the certification statement stated in 5 CFR 1320.9.