[Federal Register Volume 75, Number 176 (Monday, September 13, 2010)]
[Notices]
[Pages 55625-55626]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-22772]


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DEPARTMENT OF STATE

[Public Notice: 7156]


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

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 History and 
Examination for Foreign Service .
     OMB Control Number: 1405-0068.
     Type of Request: Revision of Currently Approved 
Collection.
     Originating Office: Office of Medical Services, M/MED/C/
MC.
     Form Number: DS-1622, DS-1843, DS-1622P, and DS-1843P.
     Respondents: Foreign Service Officers, State Department 
Employees, Other Government Employees and Family Members.
     Estimated Number of Respondents: 7,500 per year.
     Estimated Number of Responses 7,500 per year.
     Average Hours per Response: 1.0 hours per response.
     Total Estimated Burden: 7,500 hours.
     Frequency: On occasion.
     Obligation to Respond: Mandatory.

DATES: Submit comments to the Office of Management and Budget (OMB) for 
up to 30 days from August 30, 2010.

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.

[[Page 55626]]

     Mail (paper, disk, or CD-ROM submissions): Department of 
State, Office of Medical Services, SA-1 Room L-101, (ATTN: Susan 
Willig), 2401 E St., NW., Washington, DC 20522-0101
     Fax: 202-663-1934.
     If you have access to the Internet, you can view this 
notice and provide comments by going to http://www.regulations.gov/search/Regs/home.html#home.
    You must include the DS form number (if applicable), information 
collection title, and OMB control number in any correspondence.

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 Columbia Plaza Room L101, (ATTN: Susan Willig), 
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-1622(P) and DS-1843(P) are 
designed to collect medical information to provide medical providers 
with current and adequate information to base decisions on medical 
suitability for a federal employee and family members for assignment 
abroad. DS-1622 is for Children 11 years and under. DS-1843 is for 
Children 12 years and older. All forms will allow medical personnel to 
verify that there are sufficient medical resources at a diplomatic 
mission abroad to maintain the health and fitness of the individual and 
family members within the Department of State medical program.
    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: September 2, 2010.
Sharon Ludan,
Executive Director, Office of Medical Services, Department of State.
[FR Doc. 2010-22772 Filed 9-10-10; 8:45 am]
BILLING CODE 4710-36-P