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Medical Clearance Update
Medical Clearance Update
OMB: 1405-0131
IC ID: 264603
OMB.report
STATE/AFA
OMB 1405-0131
ICR 202503-1405-004
IC 264603
( )
Documents and Forms
Document Name
Document Type
Form DS-3057
Medical Clearance Update
Form and Instruction
DS-3057 Medical Clearance Update
ds3057 - DRAFT - 03-18-2025.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medical Clearance Update
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
DS-3057
Medical Clearance Update
ds3057 - DRAFT - 03-18-2025.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
Medical Clearance Update
FR Citation:
88 FR 67857
Number of Respondents:
8,782
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
8,782
0
0
0
0
8,782
Annual IC Time Burden (Hours)
4,391
0
0
0
0
4,391
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.