Notice2026-03038
60-Day Notice of Proposed Information Collection: Employee Self-Certification and Ability To Perform in Emergencies (ESCAPE) Posts, Pre-Deployment Physical Exam Acknowledgement Form
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
February 17, 2026
Issuing agencies
State Department
Abstract
The Department of State is seeking Office of Management and Budget (OMB) approval for the information collection described below. In accordance with the Paperwork Reduction Act of 1995, we are requesting comments on this collection from all interested individuals and organizations. The purpose of this notice is to allow 60 days for public comment preceding submission of the collection to OMB.
Full Text
<html>
<head>
<title>Federal Register, Volume 91 Issue 31 (Tuesday, February 17, 2026)</title>
</head>
<body><pre>
[Federal Register Volume 91, Number 31 (Tuesday, February 17, 2026)]
[Notices]
[Pages 7363-7364]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-03038]
-----------------------------------------------------------------------
DEPARTMENT OF STATE
[Public Notice 12946]
60-Day Notice of Proposed Information Collection: Employee Self-
Certification and Ability To Perform in Emergencies (ESCAPE) Posts,
Pre-Deployment Physical Exam Acknowledgement Form
ACTION: Notice of request for public comment.
-----------------------------------------------------------------------
SUMMARY: The Department of State is seeking Office of Management and
Budget (OMB) approval for the information collection described below.
In accordance with the Paperwork Reduction Act of 1995, we are
requesting comments on this collection from all interested individuals
and organizations. The purpose of this notice is to allow 60 days for
public comment preceding submission of the collection to OMB.
DATES: The Department will accept comments from the public up to April
20, 2026.
ADDRESSES:
You may submit comments by any of the following methods:
<bullet> Web: Persons with access to the internet may comment on
this notice by going to <a href="http://www.Regulations.gov">www.Regulations.gov</a>. You can search for the
document by entering ``Docket Number: DOS-2026-0232'' in the Search
field. Then click the ``Comment Now'' button and complete the comment
form.
<bullet> Email: <a href="/cdn-cgi/l/email-protection#3875594a4c51565d4272790f784b4c594c5d165f574e"><span class="__cf_email__" data-cfemail="ade0ccdfd9c4c3c8d7e7ec9aedded9ccd9c883cac2db">[email protected]</span></a>.
<bullet> Regular Mail: Send written comments to: Medical Director,
Office of Medical Clearances, Bureau of Medical Services, 2401 E Street
NW, SA-1, Room L-101, Washington, DC 20522-0101.
<bullet> Fax: 202-647-0292, Attention: Medical Clearance Director.
You must include the DS form number (if applicable), information
collection title, and the OMB control number in any correspondence.
FOR FURTHER INFORMATION CONTACT: Direct requests for additional
information regarding the collection listed in this notice, including
requests for copies of the proposed collection instrument and
supporting documents, to Jessica Martinez, Director of Medical
Clearances, who may be reached on (202) 663-1657 or at
<a href="/cdn-cgi/l/email-protection#8fc2eefdfbe6e1eaf5c5ceb8cffcfbeefbeaa1e8e0f9"><span class="__cf_email__" data-cfemail="9bd6fae9eff2f5fee1d1daacdbe8effaeffeb5fcf4ed">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
<bullet> Title of Information Collection: Employee Self-
Certification and Ability to Perform in Emergencies (ESCAPE) Posts,
Pre-Deployment Physical Exam Acknowledgement Form.
<bullet> OMB Control Number: 1405-0224.
<bullet> Type of Request: Revision of a Currently Approved
Collection.
<bullet> Originating Office: Bureau of Medical Services, Office of
Medical Clearances MED/CP/CS/CL.
<bullet> Form Number: DS-6570.
<bullet> Respondents: Contractors and eligible family members
deploying to ESCAPE Diplomatic Missions requesting access to the
Department of State Medical Program (currently Iraq, Juba, Kyiv, Libya,
Peshawar, Somalia, Syria, and Yemen).
<bullet> Estimated Number of Respondents: 1,900.
<bullet> Estimated Number of Responses: 1,900.
<bullet> Average Time per Response: 40 Minutes.
<bullet> Total Estimated Burden Time: 1,266 hours.
<bullet> Frequency: Annually for those deployed to an ESCAPE post.
<bullet> Obligation to Respond: Required to Obtain or Retain a
Benefit.
We are soliciting public comments to permit the Department to:
<bullet> Evaluate whether the proposed information collection is
necessary for the proper functions of the Department.
<bullet> Evaluate the accuracy of our estimate of the time and cost
burden for this proposed collection, including the validity of the
methodology and assumptions used.
<bullet> Enhance the quality, utility, and clarity of the
information to be collected.
<bullet> Minimize the reporting burden on those who are to respond,
including the use of automated collection techniques or other forms of
information technology.
Please note that comments submitted in response to this Notice are
public record. Before including any detailed personal information, you
should be aware that your comments as submitted, including your
personal information, will be available for public review.
Abstract of Proposed Collection
The DS-6570 is completed by an individual and their medical
provider to declare that the individual has health concerns that may
represent a safety hazard for the individual or others at an
[[Page 7364]]
ESCAPE Diplomatic Mission. ESCAPE is an acronym used to describe
Diplomatic Missions overseas that are in extremely high threat,
potentially combat, areas. Current ESCAPE Missions are Iraq, Juba,
Kyiv, Libya, Peshawar, Somalia, Syria, and Yemen. This program is
authorized under the Foreign Service Act of 1980, as implemented by the
Department in 13 FAM 301.4-5.
Methodology
The respondents will be prompted access to the forms digitally
based on their medical clearance needs (ESCAPE post designation). They
will then take it to their personal medical provider for completion and
authorization. Once complete, the forms will be submitted via a secure
online platform for review by the Office of Medical Clearances.
Jessica Martinez,
Director of Medical Clearances,Bureau of Medical Services,Department of
State.
[FR Doc. 2026-03038 Filed 2-13-26; 8:45 am]
BILLING CODE 4710-36-P
</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>Indexed from Federal Register on February 17, 2026.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.