View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
3145-0177
ICR Reference No:
201404-3145-001
Status:
Historical Active
Previous ICR Reference No:
201101-3145-003
Agency/Subagency:
NSF
Agency Tracking No:
Title:
Medical Clearance Process for Deployment to the Polar Regions
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/19/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/28/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2017
36 Months From Approved
06/30/2014
Responses
3,300
0
27,965
Time Burden (Hours)
33,600
0
34,907
Cost Burden (Dollars)
1,075,008
0
0
Abstract:
The National Science Foundation requires all U.S. Antarctic participants and all participants deploying to Greenland and other select regions of the Arctic to take and pass a physical examination prior to deployment. NSF uses the information to determine the medical and dental health and psychological suitability of the polar participants; to determine whether accommodations exist to treat certain ailments and to provide on-site treatment, when needed, without doing harm. The respondents are all USAP participants; all Greenland participants in select regions of the Arctic that are under the auspices of USAP.
Authorizing Statute(s):
US Code:
42 USC 1870
Name of Law: General Authority of Foundation
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 68479
11/14/2013
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 23013
04/25/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medical Clearance Process for Deployment to the Polar Regions
NSF-1700
Medical Clearance Process for Deployment to the Polar Regions
NSF 1421-A, Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica
1421-A
Medical Risks for NSF-Sponsored Personnel Traveling to Antarctica
NSF 1421-B, Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions - Arctic
1421
Medical Risks for NSF- Sponsored Personnel Traveling to the Polar Regions
NSF 1422, Polar Physical Examination - Medical History - Antarctica
1422
Polar Phsyical Examination - Medical History
NSF 1423-A, Polar Physical Examination - Antarctica
1423
Polar Physical Exam
NSF 1423-B, Polar Physical Examination
1423-B
Polar Physical Exam
NSF 1423-C, Polar Physical Examination
1423-C
Polar Physical Exam
NSF 1424, Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test
1424
Medical Screening for Blood-Borne Pathogens/Consent for HIV Antibody Blood Test
NSF 1425-A, Polar Dental Examination - Antarctica
1425-A
Polar Dental Examination
NSF 1425-B, Polar Dental Examination - Arctic
1425-B
Polar Dental Examination - Arctic
NSF 1427, Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years
1427
Authorization for Treatment of Field-Team Member/Participant Under the Age of 18 Years
NSF 1428-A, Request for Waiver of NSF/OPP Medical Requirements-Antarctica
1428-A
Request for Waiver of NSF/OPP Medical Requirements - Antarctica
NSF 1428-B, Request for Waiver of NSF/OPP Medical Requirements-Arctic
1428-B
Request for Waiver of NSF/OPP Medical Requirements-Arctic
NSF 1429-A, Employer Statement of Support for Waiver Request-Antarctic
1429-A
Employer Statement of Support for Waiver Request
NSF 1429-B, Employer Statement of Support for Waiver Request-Arctic
1429-B
Employer Statement of Support for Waiver Request-Arctic
NSF 1429-I, Individual Statement of Sujpport
1429-I
Individual Statement of Support
NSF 1457, Important Notice for Participants in the United States Antarctic Program
1457
Important Notice for Participants in the United States Antarctic Program
NSF 1458, Personal Information Form
1458
Personal Information Form
NSF 1461, Privacy Notice, Antarctica
1461, NSF 1461
Privacy Notice - Antarctica
,
Privacy Notice and Paperwork Reduction Act Statement
Privacy Notice - Arctic
Privacy Notice, Antarctica
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
3,300
27,965
0
-24,665
0
0
Annual Time Burden (Hours)
33,600
34,907
0
-1,307
0
0
Annual Cost Burden (Dollars)
1,075,008
0
0
1,075,008
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The program has streamlined the format of the Polar Programs medical process, combining 15+ separate forms into one continuous packet, eliminating duplication and including a pre-filled format.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Suzanne Plimpton
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/28/2014
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