[Federal Register Volume 61, Number 221 (Thursday, November 14, 1996)]
[Notices]
[Page 58438]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-29094]


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DEPARTMENT OF THE TREASURY

Proposed Collection; Comment Request; Medical History Form

AGENCY: U.S. Customs, Department of the Treasury.

ACTION: Notice and request for comments.

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SUMMARY: As part of its continuing effort to reduce paperwork and 
respondent burden, Customs invites the general public and other Federal 
agencies to comment on an information collection requirement concerning 
the Medical History Form. This request for comment is being made 
pursuant to the Paperwork Reduction Act of 1995 (Public Law 104-13; 44 
U.S.C. 3505(c)(2)).

DATES: Written comments should be received on or before January 13, 
1997, to be assured of consideration.

ADDRESSES: Direct all written comments to U.S. Customs Service, 
Printing and Records Services Group, Room 6216, 1301 Constitution Ave., 
NW, Washington, D.C. 20229.

FOR FURTHER INFORMATION CONTACT: Requests for additional information or 
copies of the form(s) and instructions should be directed to U.S. 
Customs Service, Attn.: J. Edgar Nichols, Room 6216, 1301 Constitution 
Avenue NW, Washington, D.C. 20229, Tel. (202) 927-1426.

SUPPLEMENTARY INFORMATION: Customs invites the general public and other 
Federal agencies to comment on proposed and/or continuing information 
collections pursuant to the Paperwork Reduction Act of 1995 (Public Law 
104-13; 44 U.S.C. 3505(c)(2)). The comments should address: (a) whether 
the collection of information is necessary for the proper performance 
of the functions of the agency, including whether the information shall 
have practical utility; (b) the accuracy of the agency's estimates of 
the burden of the collection of information; (c) ways to enhance the 
quality, utility, and clarity of the information to be collected; (d) 
ways to minimize the burden including the use of automated collection 
techniques or the use of other forms of information technology; and (e) 
the annual costs burden to respondents or record keepers from the 
collection of information (a total capital/startup costs and operations 
and maintenance costs). The comments that are submitted will be 
summarized and included in the Customs request for Office of Management 
and Budget (OMB) approval. All comments will become a matter of public 
record. In this document Customs is soliciting comments concerning the 
following information collection:
    Title: Medical History Form.
    OMB Number: 1515-0202.
    Form Number: Customs Forms 426 and 427.
    Abstract: These forms are used to determine medical history of 
persons tentatively selected for positions that are considered arduous 
or hazardous. This information is provided to the physician who conduct 
the physical examinations prior to final selection.
    Current Actions: There are no changes to the information 
collection. This submission is being submitted to extend the expiration 
date.
    Type of Review: Extension (without change).
    Affected Public: Individuals.
    Estimated Number of Respondents: 700.
    Estimated Time Per Respondent: 45 minutes.
    Estimated Total Annual Burden Hours: 525.
    Estimated Total Annualized Cost on the Public: $6,300.

    Dated: October 31, 1996.
V. Carol Barr,
Printing and Records Services Group.
[FR Doc. 96-29094 Filed 11-13-96; 8:45 am]
BILLING CODE 4820-02-P