[Federal Register Volume 71, Number 60 (Wednesday, March 29, 2006)]
[Notices]
[Pages 15796-15797]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-4553]


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DEPARTMENT OF STATE

[Public Notice 5355]


30-Day Notice of Proposed Information Collection: DS 1843 and 
1622, Medical History and Examination for Foreign Service, OMB 1405-
0068

ACTION: Notice of request for public comment and submission to OMB of 
proposed collection of information.

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SUMMARY: The Department of State has submitted the following 
information collection request to the Office of

[[Page 15797]]

Management and Budget (OMB) for approval in accordance with the 
Paperwork Reduction Act of 1995.
    Title of Information Collection: Medical History and Examination 
for Foreign Service.
    OMB Control Number: 1405-0068.
    Type of Request: Extension of a Currently Approved Collection.
    Originating Office: Office of Medical Services, M/MED/EX.
    Form Number: DS 1843 and DS-1622.
    Respondents: Family members of Foreign Service Officers and Federal 
employees stationed abroad.
    Estimated Number of Respondents: 9,800.
    Estimated Number of Responses: 9,800.
    Average Hours Per Response: 1.
    Total Estimated Burden: 9,800 hours.
    Frequency: Tour of Duty.
    Obligation to Respond: Required to obtain a benefit.

DATES: Comments from the public will be accepted up to April 28, 2006.

ADDRESSES: Direct comments and questions to Alex Hunt, the Department 
of State Desk Officer in the Office of Information and Regulatory 
Affairs at the Office of Management and Budget (OMB), who may be 
reached at 202-395-7860. 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): Office of Information 
and Regulatory Affairs, Office of Management and Budget, 725 17th 
Street, NW., Washington, DC 20503.
    Fax: 202-395-6974.

FOR FURTHER INFORMATION CONTACT: You may obtain copies of the proposed 
information collection and supporting documents from 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 at [email protected].

SUPPLEMENTARY INFORMATION: We are soliciting public comments to permit 
the Department to:
    Evaluate whether the proposed information collection is necessary 
to properly perform 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.
    Abstract of proposed collection: Form DS-1843 and DS-1622 are 
designed to collect medical information that gives medical providers 
the current and adequate information needed to decide whether or not a 
Federal employee, and family members, will have sufficient medical 
resources at a diplomatic mission abroad.
    Methodology: The information will be collected through the use of 
an electronic forms engine, or by hand written submission using a pre-
printed form.

    Dated: March 7, 2006.
Maria C. Melchiorre,
Deputy Executive Director, Office of Medical Services, Department of 
State.
 [FR Doc. E6-4553 Filed 3-28-06; 8:45 am]
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