OMB control number
Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)
OMB 1405-0224 · STATE/AFA.
OMB 1405-0224
The purpose for soliciting this information is to make appropriate medical clearance decisions that better assess potential bidders that are capable of the unique, potentially challenging and life-threatening conditions at Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) posts and are capable of performing certain emergency safety functions.
The latest form for Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) expires 2026-08-31 and is listed under ICR 202209-1405-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form DS-6570 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) | Form and Instruction |
 Legal Authorities 1405-0224 (DS-6570).docx | Supplementary Document |
| Supporting Statement 1405-0224 (DS-6570) 30day.docx | Supporting Statement A |
 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202209-1405-002 | Revision of a currently approved collection | 2022-09-27 | Approved without change | |
| 202001-1405-002 | Revision of a currently approved collection | 2020-01-31 | Approved with change | |
| 201611-1405-004 | Revision of a currently approved collection | 2016-11-28 | Approved without change | |
| 201605-1405-002 | New collection (Request for a new OMB Control Number) | 2016-05-10 | Approved without change |