Agency Information Collection Activities; Proposals, Submissions, and Approvals: Pre-Employment Medical and Driver Evaluation Forms

30-Day Notice of Proposed Information Collection: Pre-Employment Medical and Driver Evaluation Forms

Dates

Submit comments up to September 11, 2024.

Supplementary Information

• Title of Information Collection: Pre-Employment Medical and Driver Evaluation Forms.

• OMB Control Number: None.

• Type of Request: New Collection.

• Originating Office: Bureau of Medical Services, Office of Occupational Health and Wellness, MED/CP/HS/OH.

• Form Number: DS-6571, DS-6572, DS-6573, DS-6574, DS-6575, DS-6576, DS-6577.

• Respondents: Prospective locally employed staff employees and prospective/current employees who require a driver certificate to operate a government owned vehicle overseas.

• Estimated Number of Respondents: 13,000.

• Estimated Number of Responses: 13,000.

• Average Time per Response: 2.66 hours.

• Total Estimated Burden Time: 34,550.

• Frequency: Once, every two years, or every four years depending on occupation requirements.

• Obligation to Respond: Voluntary.

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

This collection is necessary for the Department's Bureau of Medical Services to evaluate medical eligibility for employment regarding operating a government owned vehicle, and for gathering supplemental pertinent medical information regarding identified conditions that could pose a safety risk to employees and others. This collection consists of the following forms: the medical evaluation for locally employed staff non-drivers (DS-6571); a tuberculosis risk assessment (DS-6573); a driver medical evaluation for locally employed staff (DS-6572); a driver medical evaluation for U.S. Direct Hire (DS-6576); and supplemental health questionnaires. The supplemental health questionnaires are utilized for vision related (DS-6577), seizure related (DS-6574), and diabetes related diagnoses (DS-6575). These questionnaires and concurrent medical evaluations are required to make informed assessments on ability to complete required employment-related tasks; implementation of this collection is pursuant to 5 CFR 930.108, 339.301, and the Foreign Service Act of 1980, as amended, 22 U.S.C. 4084, 3901, and 3984.

Methodology

The respondent will download the forms from a Department website. The respondent will complete and submit the forms to the local Health Unit and schedule an evaluation.