Notice2026-04650
30-Day Notice of Proposed Information Collection: Medical History and Examination
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
March 10, 2026
Issuing agencies
State Department
Abstract
The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. 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 30 days for public comment.
Full Text
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<title>Federal Register, Volume 91 Issue 46 (Tuesday, March 10, 2026)</title>
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[Federal Register Volume 91, Number 46 (Tuesday, March 10, 2026)]
[Notices]
[Page 11589]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-04650]
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DEPARTMENT OF STATE
[Public Notice 12957]
30-Day Notice of Proposed Information Collection: Medical History
and Examination
ACTION: Notice of request for public comment and submission to OMB of
proposed collection of information.
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SUMMARY: The Department of State has submitted the information
collection described below to the Office of Management and Budget (OMB)
for approval. 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
30 days for public comment.
DATES: Submit comments up to April 9, 2026.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
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 Director of Medical Clearances, Jessica
Martinez, who may be reached on (202) 663-1657 or at
<a href="/cdn-cgi/l/email-protection#327f5340465b5c57487873057241465346571c555d44"><span class="__cf_email__" data-cfemail="6825091a1c01060d1222295f281b1c091c0d460f071e">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
<bullet> Title of Information Collection: Medical History and
Examination.
<bullet> OMB Control Number: 1405-0068.
<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-1843 and DS-1622.
<bullet> Respondents: Chief of Mission personnel and eligible
family members.
<bullet> Estimated Number of Respondents: 2,039.
<bullet> Estimated Number of Responses: 2,039.
<bullet> Average Time per Response: 1 hour.
<bullet> Total Estimated Burden Time: 2,0390 hours.
<bullet> Frequency: Upon application/employment for an overseas
position and then intermittent, as needed.
<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
Forms DS-1843 and DS-1622 collect medical history, screenings and
physical examinations for all individuals applying for overseas
positions, including their eligible family members. Forms DS-1843 and
DS-1622 are designed to collect sufficient and current medical
information on the individual for a medical provider to make a medical
clearance determination for initial appointment to an overseas
assignment. They are also used to determine whether the individual or
eligible family member will have appropriate medical and/or educational
resources at a diplomatic mission/host country abroad to maintain the
health and safety of the individual or family member. The forms were
updated to include questions regarding employment agency information
for non-foreign service agencies.
Methodology
The respondent will initially answer the questions on pages 1-3 of
the forms digitally. They will then be prompted to download the auto
populated form with their responses and take it to their personal
medical provider for completion and authorization of pages 4-5. Once
complete, the forms will be submitted via a secure online platform for
review by the Office of Medical Clearances.
Jessica A. Martinez,
Director of Medical Clearances, Bureau of Medical Services, Department
of State.
[FR Doc. 2026-04650 Filed 3-9-26; 8:45 am]
BILLING CODE 4710-36-P
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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.