[Federal Register Volume 70, Number 35 (Wednesday, February 23, 2005)]
[Notices]
[Page 8873]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-3433]


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DEPARTMENT OF STATE

[Public Notice 4999]


60-Day Notice of Proposed Information Collection: Form DS-3057, 
Medical Clearance Update, OMB 1405-0131

ACTION: Notice of request for public comments.

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SUMMARY: The Department of State is seeking Office of Management and 
Budget (OMB) approval for the information collection described below. 
The purpose of this notice is to allow 60 days for public comment in 
the Federal Register preceding submission to OMB. We are conducting 
this process in accordance with the Paperwork Reduction Act of 1995.
     Title of Information Collection: Medical Clearance Update.
     OMB Control Number: 1405-0131.
     Type of Request: Extension of Currently Approved 
Collection.
     Originating Office: Office of Medical Services, M/MED/EX.
     Form Number: DS-3057.
     Respondents: Foreign Service Officers, Federal Government 
Employees and family members.
     Estimated Number of Respondents: 9,800.
     Estimated Number of Responses: 9,800.
     Average Hours Per Response: 30 minutes.
     Total Estimated Burden: 4,900.
     Frequency: On occasion.
     Obligation to Respond: Required To Obtain or Retain a 
Benefit.

DATES: The Department will accept comments from the public up to 60 
days from February 23, 2005.

ADDRESSES: You may submit comments by any of the following methods:
     E-mail: [email protected]. You must include the DS form 
number, information collection title, and OMB control number in the 
subject line of your message.
     Mail (paper, disk, or CD-ROM submissions): Department of 
State, Office of Medical Services, SA-1 Room L-101, 2401 E St., NW., 
Washington, DC 20052-0101.
     Fax: 202-663-1661.

FOR FURTHER INFORMATION CONTACT: Direct requests for additional 
information regarding the collection listed in this notice, including 
requests for copies of the proposed information collection and 
supporting documents, to Susan Willig, Department of State, Office of 
Medical Services, SA-1 Room L101, 2401 E St., NW., Washington, DC 
20052-0101, who may be reached on 202-663-1754 or [email protected].

SUPPLEMENTARY INFORMATION:
    We are soliciting public comments to permit the Department to:
     Evaluate whether the proposed information collection is 
necessary for the proper performance of our functions.
     Evaluate the accuracy of our estimate of the burden of the 
proposed collection, including the validity of the methodology and 
assumptions used.
     Enhance the quality, utility, and clarity of the 
information to be collected.
     Minimize the reporting burden on those who are to respond, 
including the use of automated collection techniques or other forms of 
technology.
    Abstract of proposed collection: Form DS-3057 is designed to 
collect medical information to provide medical providers with current 
and adequate information to base decisions on whether a federal 
employee and family members will have sufficient medical resources at a 
diplomatic mission abroad to maintain the health and fitness of the 
individual and family members.
    Methodology: The information collected will be collected through 
the use of an electronic forms engine or by hand written submission 
using a pre-printed form.

    Dated: January 30, 2005.
Maria C. Melchiorre,
Administrative Officer, Office of Medical Services, Department of 
State.
[FR Doc. 05-3433 Filed 2-22-05; 8:45 am]
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