View Information Collection Request (ICR) Package

OMB Control No: 1405-0224	ICR Reference No: 201605-1405-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 05/23/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/24/2016
	Date Received in OIRA: 05/10/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	6 Months From Approved
Responses	200	0	0
Time Burden (Hours)	100	0	0
Cost Burden (Dollars)	0	0	0

Abstract: 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.

Emergency Justfication: The goal of the “Employee Self Certification and Ability To Perform In Emergencies” (ESCAPE) program is to ensure that non-federal individuals who are seeking a contracted position at a designated post are capable of the unique, potentially challenging and life-threatening conditions at ESCAPE posts and are capable of performing certain emergency safety functions. Individuals are required to review with a medical provider the pre-deployment acknowledgement form and then affirm that they understand the physical rigors and security conditions at these posts and can perform any specified emergency functions. A working group at the State Department has developed this program at the direction of the Under Secretary for Management (M). In the past, a number of individuals have not been able to successfully complete their assignments to these posts because of limiting medical or physical limitations that were not identified before deployment. These limiting conditions put not only these individuals at risk but also post personnel and property. ESCAPE posts are located in Afghanistan, Iraq, Libya, and Yemen. There is a need for an emergency review and approval before the next group of individuals are deployed to these posts in June, 2016 to ensure all can perform their responsibilities.

Authorizing Statute(s): US Code: 22 USC 3901 Name of Law: the Foreign Service Act of 1980

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
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
Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)	DS-6570

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	200	200
Annual Time Burden (Hours)	100	100
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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: Paula Dolan 202 663-1519

View ICR - OIRA Conclusion