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View ICR - OIRA Conclusion

OMB Control No: 0420-0510	ICR Reference No: 202509-0420-001
Status: Active	Previous ICR Reference No: 202407-0420-002
Agency/Subagency: PEACE	Agency Tracking No: PC-1789
Title: Peace Corps Health History Form
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/14/2026
	Date Received in OIRA: 09/30/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2029	36 Months From Approved
Responses	12,500	0	0
Time Burden (Hours)	6,250	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,500	-10,500	23,000
Annual Time Burden (Hours)	6,250	-11,000	17,250
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: Cutting Redundancy

Short Statement: The Health History Form was updated to reflect the Executive Orders issued by the current Administration. It has been modified to reduce the number of questions to be answered.

Annual Cost to Federal Government: $100,000

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: Jay Olin 202 692-2507 jolin@peacecorps.gov

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