OMB control number
Certificate of Medical Examination
OMB 0583-0167 ยท USDA/FSIS.
OMB 0583-0167
to collect certificates of medical examination to determine whether or not an applicant for an FSIS Food Inspector, Consumer Safety Inspector, or Veterinary Medical Officer in-plant position meets the Office of Personnel Management (OPM) approved medical qualification standards and to collection information for requests for reasonable accommodations
The latest form for Certificate of Medical Examination expires 2028-12-31 and is listed under ICR 202504-0583-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 4339-1 Certificate of Medical Examination with report of Medical History | Form and Instruction |
| Form 4306-5 Medical Documentation for Employees Reasonable Accommodation Request | Form and Instruction |
| Form 4306-5 Certificates of Medical Examination | Form and Instruction |
 supporting statement A certificates of medical examination 2025.docx | Supporting Statement A |
| supporting statement A certificates of medical examination 2025.docx | Supporting Statement A |
 Certificates of Medical Examination |
Form and Instruction |
| Certificates of Medical Examination |
Form and Instruction |
| Certificates of Medical Examination |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202504-0583-001 | Extension without change of a currently approved collection | 2025-11-17 | ||
| 202206-0583-003 | Revision of a currently approved collection | 2022-09-27 | Approved with change | |
| 202005-0583-002 | No material or nonsubstantive change to a currently approved collection | 2020-05-20 | Approved without change | |
| 202001-0583-003 | No material or nonsubstantive change to a currently approved collection | 2020-01-13 | Approved without change | |
| 201910-0583-001 | Revision of a currently approved collection | 2019-10-18 | Approved with change | |
| 201810-0583-003 | Extension without change of a currently approved collection | 2018-12-03 | Approved without change | |
| 201508-0583-001 | New collection (Request for a new OMB Control Number) | 2015-09-25 | Approved with change |