Information Collection

Medical Clearance Update

IC 15003 under ICR 201402-1405-003 · OMB 1405-0131.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0131 can be found here:

Documents and Forms

Document Name Document Type
Form DS-3057 Medical Clearance Update Form
DS-3057 Medical Clearance Update DS-3057.pdf Form

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: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DS-3057	Medical Clearance Update	DS-3057.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,280	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16,280	6,480	9,800
Annual IC Time Burden (Hours)	8,140	3,240	4,900
Annual IC Cost Burden (Dollars)	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.