Fire and Aviation Management Medical Qualifications Program

OMB 0596-0164

Medical history, which is provided by completing the Health Screening Questionaire, Medical Qualifications Program Medical Exam and Self-Certification Statement supplies information needed to determine certification of suitability, any special medical or medication needs, and a file record to protect both the Federal Government and individuals.

The latest form for Fire and Aviation Management Medical Qualifications Program expires 2022-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form FS-5100-30 Fire and Aviation Medical Management Qualifications Program Form
0596-0164 -- Burden-cost Spreadsheet.Final_sem.xlsm Supplementary Document
0596-0164 Supporting Statement A_Final_SEM.docx Supporting Statement A
Burden Hour Revision Justification 2022.docx Justification for No Material/Nonsubstantive Change
Fire and Aviation Medical Management Qualifications Program Form

All Historical Document Collections

202201-0596-006 Approved without change	Revision of a currently approved collection	2022-11-23
201906-0596-003 Approved without change	Revision of a currently approved collection	2019-06-27
201701-0596-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-02-09
201603-0596-004 Approved without change	Revision of a currently approved collection	2016-03-30
201506-0596-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-07-01
201212-0596-001 Approved without change	Extension without change of a currently approved collection	2013-01-17
200907-0596-002 Approved without change	Revision of a currently approved collection	2009-08-28
200606-0596-002 Approved with change	Revision of a currently approved collection	2006-06-27
200503-0596-007 Approved with change	Reinstatement without change of a previously approved collection	2005-03-30
200501-0596-003 Improperly submitted	Reinstatement with change of a previously approved collection	2005-01-26
200408-0596-001 Improperly submitted	Extension without change of a currently approved collection	2004-08-30
200107-0596-001 Approved without change	New collection (Request for a new OMB Control Number)	2001-07-11