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View ICR - OIRA Conclusion

OMB Control No: 0990-0324	ICR Reference No: 201612-0990-001
Status: Historical Active	Previous ICR Reference No: 200710-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Report of Medical History/Examination
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/02/2017
	Date Received in OIRA: 03/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	03/31/2011
Responses	14,120	0	4,000
Time Burden (Hours)	4,109	0	1,000
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	14,120	4,000	10,120
Annual Time Burden (Hours)	4,109	1,000	3,109
Annual Cost Burden (Dollars)	0	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 change included the removal of PHS-7059 (Report of Medical Examination) and PHS-7060 (Report of Medical History). These forms were replaced with DD 2807-1 (Report of Medical History). As stated previously, no additional response burden was required because the medical certifications are performed on Department of Defense DoD) forms included in the application process and the response burden is accounted for therein. However, the implementation of PHS-6355 (Report of Dental Examination of Applicants to the Commissioned Corps of the Public Health Service) and PHS-6379 (Supplemental Medical History Record Required of Applicants to the Public Health Service Commissioned Corps) increased the response burden hours. The average amount of time required to complete all forms is included in 12A.

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