Information Collection

Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)

IC 221440 under ICR 202608-1405-002 · OMB 1405-0224.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-6570 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)	Form and Instruction
DS-6570 Employee Self-Certification and Ability to Perform in Em DS-6570 ESCAPE Posts Physical Exam Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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-6570				Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title: Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)

FR Citation: 91 FR 13099

Number of Respondents: 1,900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,900	1,368	532
Annual IC Time Burden (Hours)	1,266	734	532
Annual IC Cost Burden (Dollars)	0	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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