Information Collection

Medical Clearance Update

IC 15003 under ICR 202301-1405-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 and Instruction
DS-3057 Medical Clearance Update DS-3057.pdf Form and Instruction
DS-3057 Medical Clearance Update DS-3057.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: 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-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: 7,205	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,205	7,205
Annual IC Time Burden (Hours)	3,603	3,603
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.