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:
1105-0099
ICR Reference No:
202406-1105-004
Status:
Active
Previous ICR Reference No:
201911-1105-001
Agency/Subagency:
DOJ/LA
Agency Tracking No:
1105-0099
Title:
USMS Medical Forms
Type of Information Collection:
Reinstatement with change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/30/2026
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/21/2025
Terms of Clearance:
In accordance with 5 CFR 1320, this information collection is approved
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2029
36 Months From Approved
Responses
1,139
0
0
Time Burden (Hours)
2,783
0
0
Cost Burden (Dollars)
157,014
0
0
Abstract:
As a law enforcement agency, the United States Marshals Service has unique medical requirements that prevent USMS from using current medical-related Standard and Optional forms. These forms have been developed to allow USMS to ensure that the applicants, contract employees and current federal employees who work in operational law enforcement positions are physically fit enough to perform their duties safely and successfully.
Authorizing Statute(s):
EO: EO 9397 Name/Subject of EO: Numbering system for federal accounts relating to individual persons
US Code:
28 USC 566
Name of Law: Powers and duties
US Code:
5 USC 3301
Name of Law: Civil service; generally
US Code:
5 USC 3312
Name of Law: Preference eligibles; physical qualifications; waiver
US Code:
5 USC 552a
Name of Law: Records maintained on individuals
US Code:
28 USC 561
Name of Law: United States Marshals Service
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:
90 FR 18868
05/02/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 30100
07/08/2025
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
CSO-012 Request to Reevaluate Court Security Officer's Medical Qualifications
CSO-012, OMB #1105-0099
Request to Reevaluate Court Security Officer's Medical Qualification
,
Request to Reevaluate Court Security Officer's Medical Qualification
SSO-012 Request to Reevaluate Special Security Officer's Medical Qualifications
SSO-012
Request to Reevaluate Special Security Officer's Medical Qualifications
USM-522A Physician Evaluation Report for USMS Operational Employees
USM-522A
Physician Evaluation Report for USMS Operational Employees
USM-522P Physician Evaluation Report for USMS Operational Employees - Pregnancy Only
USM-522P
Physician Evaluation Report for USMS Operational Employees - Pregnancy Only
USM-602 Contract Guard Physical Examination Report
USM-602
Contract Guard Physical Examination Report
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
1,139
0
0
27
0
1,112
Annual Time Burden (Hours)
2,783
0
0
68
0
2,715
Annual Cost Burden (Dollars)
157,014
0
0
4,293
0
152,721
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:
The SSO-012 form is a new form that was added to the USMS medical forms and resulted in the burden increase.
Annual Cost to Federal Government:
$152,721
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:
Benjamin Cho 240 401-0008 benjamin.cho@usdoj.gov
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:
07/21/2025
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