[Federal Register Volume 77, Number 130 (Friday, July 6, 2012)]
[Notices]
[Pages 39986-39987]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-16505]
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DEPARTMENT OF AGRICULTURE
Forest Service
Information Collection; Health Screening Questionnaire
AGENCY: Forest Service, USDA.
ACTION: Notice; request for comment.
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SUMMARY: In accordance with the Paperwork Reduction Act of 1995, the
Forest Service is seeking comments from all interested individuals and
organizations on the extension of a currently approved information
collection, Health Screening Questionnaire.
DATES: Comments must be received in writing on or before September 4,
2012 to be assured of consideration. Comments received after that date
will be considered to the extent practicable.
ADDRESSES: Comments concerning this notice should be addressed to
Washington Office--Fire and Aviation Management, National Interagency
Fire Center, 3833 S. Development Ave., Boise, ID 83705, Attention:
Larry Sutton.
Comments also may be submitted via facsimile to 208-387-5735 or by
email to: lsutton@fs.fed.us.
The public may inspect comments received at the National Safety
Office, National Interagency Fire Center, Forest Service, USDA, 3833
Development Avenue, Boise, ID, from 8 a.m. to 4:30 p.m. Monday through
Friday (Mountain Standard Time). Visitors are encouraged to call ahead
to 208-387-5970 to facilitate entry to the building.
FOR FURTHER INFORMATION CONTACT: Larry Sutton, Forest Service Fire
Operations Risk Management Specialist, 208-387-5970. Individuals who
use telecommunication devices for the deaf (TDD) may call the Federal
Relay Service (FRS) at 1-800-877-8339, twenty-four hours a day, every
day of the year, including holidays.
SUPPLEMENTARY INFORMATION:
Title: Health Screening Questionnaire.
OMB Number: 0596-0164.
Expiration Date of Approval: January 31, 2013.
Type of Request: Extension with revision of an approved information
collection.
Abstract: The Protection Act of 1922 (16 U.S.C. 594) authorizes the
Forest Service to fight fires on National Forest System lands. This
information collection is an approved Forest Service collection. The
collection covers the USDA Forest Service (FS) and the Department of
the Interior (DOI), and contains the information collection activities
and burden hours for both agencies.
Wildland firefighters perform long hours of arduous labor in
adverse environmental conditions. It is imperative that these
firefighters be in sufficient physical condition to avoid injury to
themselves or their coworkers. Federal employees and private
individuals seeking employment as a firefighter with the FS or DOI
complete the Health Screening Questionnaire (HSQ). This information
collection covers the forms and burden hours associated with the
private individuals who apply for firefighter positions with the
aforementioned agencies.
Prospective firefighters must complete form FS-5100-31, Health
Screening Questionnaire, when seeking employment as a new firefighter
with the Forest Service or Department of the Interior. This form
collects the following information:
Name and Unit.
Medical history.
Current medical symptoms.
Other health issues.
Cardiovascular risk factors.
The information collected pertains to an individual's health status
and health history in an effort to determine if any physical conditions
exist that might result in injury or death during fitness testing or
when fighting a wildfire. If Federal agency officials determine, based
on the collected information, that an individual may not be physically
able to train for or take a Work Capacity Test, the agency will require
the individual to undergo a physical examination by a physician.
Form FS-5100-30, Work Capacity Test: Informed Consent, is signed by
those deemed to be in sufficient health
[[Page 39987]]
to undergo a Work Capacity Test. The Work Capacity Test determines the
level of an individual's aerobic fitness, level of muscular strength,
and muscle endurance. The consent form is necessary to ensure the
individual taking the test is aware of the various testing levels
(arduous, moderate, and light) and the risks involved. The individual
indicates the following:
They have read the information on the form, the brochure
``Work Capacity Test'' and understand the purpose, instructions, and
risks of the test.
They have read the information, understood, and truthfully
answered the HSQ.
Test to be taken--pack test (arduous), field test
(moderate), or walk test (light).
Failure to collect this data could result in injuries or deaths
during the ``Work Capacity Test'' and while working on wildland fires.
The information provided by an applicant for Federal employment is
stored in secured official files, maintained according to Agency
regulations. The information gathered is not available from other
sources.
Estimate of Annual Burden: 5 Minutes.
Type of Respondents: Individuals.
Estimated Annual Number of Respondents: 7,471.
Estimated Annual Number of Responses per Respondents: 1.
Estimated Total Annual Burden on Respondents: 1,240.
Comment Is Invited
Comment is invited on: (1) Whether this collection of information
is necessary for the stated purposes and the proper performance of the
functions of the Agency, including whether the information will have
practical or scientific utility; (2) the accuracy of the Agency's
estimate of the burden of the collection of information, including the
validity of the methodology and assumptions used; (3) ways to enhance
the quality, utility, and clarity of the information to be collected;
and (4) ways to minimize the burden of the collection of information on
respondents, including the use of automated, electronic, mechanical, or
other technological collection techniques or other forms of information
technology.
All comments received in response to this notice, including names
and addresses when provided, will be a matter of public record.
Comments will be summarized and included in the submission request
toward Office of Management and Budget approval.
Dated: June 26, 2012.
Robin L. Thompson,
Associate Deputy Chief, State & Private Forestry.
[FR Doc. 2012-16505 Filed 7-5-12; 8:45 am]
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