Information Collection

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

IC 221440 under ICR 202209-1405-002 · OMB 1405-0224.

Documents and Forms

Document Name Document Type
Form DS-6570 Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Form and Instruction
DS-6570 Pre-Deployment Physical Exam Acknowledgement Form DS-6570 - DRAFT-30 day.far Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE)	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 and Instruction	DS-6570	Pre-Deployment Physical Exam Acknowledgement Form	DS-6570 - DRAFT-30 day.far		No		Paper Only

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 532	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	532	532
Annual IC Time Burden (Hours)	532	532
Annual IC Cost Burden (Dollars)	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.