OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)

ICR 202209-1405-002 · OMB 1405-0224 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form DS-6570 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Form and Instruction Modified Missing upstream
Legal Authorities 1405-0224 (DS-6570).docx Supplementary Document Uploaded 2022-09-27 Repair queued
Supporting Statement 1405-0224 (DS-6570) 30day.docx Supporting Statement A Uploaded 2022-09-27 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
221440 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Form and Instruction Modified
ICR Details
1405-0224 202209-1405-002
Received in OIRA 202001-1405-002
STATE/AFA
Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)
Revision of a currently approved collection   No
Regular 09/27/2022
  Requested Previously Approved
36 Months From Approved 06/30/2023
532 532
532 532
0 0
The purpose for soliciting this information is to make appropriate medical clearance decisions that better assess potential bidders that are capable of the unique, potentially challenging and life-threatening conditions at Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) posts and are capable of performing certain emergency safety functions.
US Code: 22 USC 3901 Name of Law: the Foreign Service Act of 1980
  
None
Not associated with rulemaking
  87 FR 11782 07/11/2022
87 FR 11870 09/27/2022
No
1
IC Title Form No. Form Name
Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) DS-6570 Pre-Deployment Physical Exam Acknowledgement Form
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 532 532 0 0 0 0
Annual Time Burden (Hours) 532 532 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$8,022
No
    Yes
    Yes
No
No
No
No
Michelle Yelland 202 663-1657
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/27/2022