View Information Collection Request (ICR) Package

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: 1405-0131	ICR Reference No: 202005-1405-001
Status: Historical Active	Previous ICR Reference No: 201703-1405-001
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Medical Clearance Update
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/19/2020
	Date Received in OIRA: 05/13/2020
Terms of Clearance: Agency made minor clarifications to the supporting statement.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	10/31/2020
Responses	7,205	0	16,280
Time Burden (Hours)	3,603	0	8,140
Cost Burden (Dollars)	0	0	1,628

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	7,205	16,280	-9,075
Annual Time Burden (Hours)	3,603	8,140	-4,537
Annual Cost Burden (Dollars)	0	1,628	-1,628

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The 7,205 respondents represent approximately a 56% decrease from the previous Paperwork Reduction Act submission which included federal employees as respondents. This year’s figure only includes members of the public such as contractors and eligible family members.

Annual Cost to Federal Government: $108,651

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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? No

Agency Contact: Kevin Suckernick 202 663-1708

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