Skip to Content


Information Collection Request; Submission for OMB Review

Document Details

Information about this document as published in the Federal Register.

Document Statistics
Document page views are updated periodically throughout the day and are cumulative counts for this document including its time on Public Inspection. Counts are subject to sampling, reprocessing and revision (up or down) throughout the day.
Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble


Peace Corps.


30-day notice and request for comments.


The Peace Corps will be submitting the following information collection requests to the Office of Management and Budget (OMB) for Extension without change of a currently approved information collection. In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35), the Peace Corps invites the general public to comment on the extension, without change, of currently approved information collection, Peace Corps Volunter Health History Form (OMB 0420-0510). This process is conducted in accordance with 5 CFR 1320.10. Peace Corps received no comments during the 60-day notice.


Comments regarding this collection must be received on or before March 12, 2014.


Interested persons are invited to submit comments regarding this proposal. Comments should refer to the proposal by name/or OMB approval number and should be sent via email to: or fax to: 202-395-3086. Attention: Desk Officer for Peace Corps.

Start Further Info


Denora Miller, FOIA/Privacy Act Officer, Peace Corps, 1111 20th Street NW., Washington, DC 20526, (202) 692-1236, or email at

End Further Info End Preamble Start Supplemental Information


Method: The Health History Form will be completed online in an interactive process in which only questions relevant to each Applicant's medical history (based on responses to previous questions) are presented.

Title: Peace Corps Volunter Health History form (PC 1789).

OMB Control Number: 0420-0510.

Type of Request: Extension without change of a currently approved collection.

Affected Public: Individuals or households

Respondents Obligation To Reply: Voluntary

Burden to the Public:

a. Estimated number of respondents10,000
b. Estimated average burden per response45 minutes
c. Frequency of responseone time
d. Annual reporting burden7,500 hours
e. Estimated annual cost to respondentsIndeterminate

General Description of Collection: The Peace Corps Act requires that Volunteers receive health examinations prior to their service. The information collected is required for consideration for Peace Corps Volunteer service. The Health History Form is used to document the medical history of each individual Applicant. It is a self-report of pre-existing medical conditions and is used to help determine whether the Applicant will, with reasonable accommodation, be able to perform the essential functions of a Peace Corps Volunteer and complete a tour of service without undue disruption due to health problems.

Request For Comment: Peace Corps invites comments on whether the proposed collection of information is necessary for proper performance of the functions of the Peace Corps, including whether the information will have practical use; the accuracy of the agency's estimate of the burden of the proposed collection of information, including the validity of the information to be collected; and, ways to minimize the burden of the collection of information on those who are to respond, including through the use of automated collection techniques, when appropriate, and other forms of information technology.

Start Signature

This notice issued in Washington, DC on February 3, 2014.

Denora Miller,

FOIA/Privacy Act Officer, Management.

End Signature End Supplemental Information

[FR Doc. 2014-02723 Filed 2-7-14; 8:45 am]