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30-Day Notice of Proposed Information Collection: Medical History and Examination

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


The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995 we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public comment.


Submit comments up to September 2, 2020.


Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to​public/​do/​PRAMain. Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function.

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Direct requests for additional information regarding the collection listed in this notice, including requests for copies of the proposed collection instrument and supporting documents to: Karl Field, Medical Director, Office of Medical Clearances, Bureau of Start Printed Page 47285Medical Services, 2401 E Street NW, SA-1, Room L-101, Washington, DC 20522-0101, and who may be reached at 202-663-1591 or at

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  • Title of Information Collection: Medical History and Examination.
  • OMB Control Number: 1405-0068.
  • Type of Request: Revision of a Currently Approved Collection.
  • Originating Office: Bureau of Medical Services (MED).
  • Form Number: DS-1843 and DS-1622.
  • Respondents: Contractors and eligible family members.
  • Estimated Number of Respondents: 2,039.
  • Estimated Number of Responses: 2,039.
  • Average Time per Response: 1 hour.
  • Total Estimated Burden Time: 2,039 hours.
  • Frequency: Upon application for an overseas position and then intermittent, as needed.
  • Obligation to Respond: Required to Obtain or Retain a Benefit.

We are soliciting public comments to permit the Department to:

  • Evaluate whether the proposed information collection is necessary for the proper functions of the Department.
  • Evaluate the accuracy of our estimate of the time and cost burden for this 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 information technology.

Please note that comments submitted in response to this Notice are public record. Before including any detailed personal information, you should be aware that your comments as submitted, including your personal information, will be available for public review.

Abstract of Proposed Collection

Forms DS-1843 and DS-1622 collect medical history, lab tests, and physical examinations for all individuals applying for overseas positions, including their eligible family members. Forms DS-1843 and DS-1622 are designed to collect sufficient and current medical information on the individual in order for a medical provider to make a medical clearance determination for initial appointment to an overseas assignment. They are also used to determine whether the individual or eligible family member will have appropriate medical and/or educational resources at a diplomatic mission/host country abroad to maintain the health and safety of the individual or family member. The forms were updated to include questions regarding employment agency information for non-foreign service agencies. Once the collection instruments have been approved, the DS-1843/1622 can be used by respondents employed by both foreign and non-foreign service agencies, rendering the DS-6561 form redundant. As a result, the DS-6561 (OMB Control No. 0194) would be discontinued upon OMB approval of the revised DS-1843 and DS-1622 forms.


The respondent will obtain the DS-1843 and DS-1622 forms from their human resources representative or download the forms from a Department website. The respondent will complete and submit the forms offline.

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Karl Field,

Director of Medical Clearances.

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[FR Doc. 2020-16853 Filed 8-3-20; 8:45 am]