[Federal Register Volume 78, Number 72 (Monday, April 15, 2013)]
[Notices]
[Pages 22294-22295]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-08689]
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DEPARTMENT OF JUSTICE
[OMB Number 1105-NEW]
Agency Information Collection Activities; Proposed Collection;
Comments Requested: USMS Medical Forms
ACTION: 60-Day Notice.
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The Department of Justice (DOJ), U.S. Marshals Service, will be
submitting the following information collection request to the Office
of Management and Budget (OMB) for review and approval in accordance
with the Paperwork Reduction Act of 1995. The proposed information
collection is published to obtain comments from the public and affected
agencies. Comments are encouraged and will be accepted for ``sixty
days'' until June 14, 2013. This process is conducted in accordance
with 5 CFR 1320.10.
If you have comments especially on the estimated public burden or
associated response time, suggestions, or need a copy of the proposed
information collection instrument with instructions or additional
information, please contact Nicole Feuerstein, U.S. Marshals Service,
CS-3/10th Fl., 2604 Jefferson Davis Hwy, Alexandria, VA 22301.
Written comments and suggestions from the public and affected
agencies concerning the proposed collection of information are
encouraged. Your comments should address one or more of the following
four points:
--Evaluate whether the proposed collection of information is necessary
for the proper performance of the functions of the agency, including
whether the information will have practical utility;
--Evaluate the accuracy of the agencies estimate of the burden of the
proposed collection of information, including the validity of the
methodology and assumptions used;
--Enhance the quality, utility, and clarity of the information to be
collected; and
--Minimize the burden of the collection of information on those who are
to respond, including through the use of appropriate automated,
electronic, mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting electronic
submission of responses.
Overview of this Information Collection
(1) Type of Information Collection: New collection.
(2) Title of the Form/Collection: USMS Medical Forms.
(3) Agency form number, if any, and the applicable component of the
Department of Justice sponsoring the collection:
Form Numbers:
--USM-522 Physical Examination Report for USMS Operational Employees.
--USM-522A Physician Evaluation Report for USMS Operational Employees.
--USM-522E Medical Update.
--USM-522K Applicant Review of Immunizations.
--USM-522P Physician Evaluation Report for USMS Operational Employees
Pregnancy Only.
--USM-600 Physical Requirements of USMS District Security Officers.
--CSO-012 Request to Reevaluate Court Security Officer's Medical
Qualification.
--CSO-229 Certificate of Medical Examination for Court Security
Officers Component for all above-listed forms: U.S. Marshals Service.
(4) Affected public who will be asked or required to respond, as
well as a brief abstract:
--USM-522 Physical Examination Report for USMS Operational Employees
[cir] Affected public: Individuals or households (Applicants to
USMS)
[cir] Brief abstract: It is the policy of the USMS to ensure a law
enforcement work force that is medically able to safely perform the
required job functions. Operational employees are required to meet
medical standards and physical requirements and are classified as
either qualified or unqualified based on review of periodic medical
examination results. All applicants for law enforcement positions must
have pre-employment physical examinations. The USMS provides and pays
for applicant medical examinations at the district contract medical
facility.
--USM-522A Physician Evaluation Report for USMS Operational Employees
[cir] Affected public: Private sector (Physicians)
[cir] Brief abstract: This form is completed by an USMS operational
employee's treating physician to report any illness/injury (other than
pregnancy) that requires restriction from full performance of duties
for longer than 80 consecutive hours.
USM-522E USMS Medical Update
[cir] Affected public: Individuals or households (Applicants to
USMS)
[cir] Brief abstract: USMS applicants must complete this form to
update their medical status in order to remain active in the hiring
process. Current USMS employees may use this form to update their
medical status in the off-cycle years of the Periodic Medical Exam
(PME) schedule.
--USM-522K Applicant Review of Immunizations
[cir] Affected public: Individuals or households (Applicants to
USMS)
[cir] Brief abstract: USMS applicants must complete this record of
immunizations if an Immunization Record Card cannot be provided with
the medical examination package.
--USM-522P Physician Evaluation Report for USMS Operational Employees
(Pregnancy Only)
[cir] Affected public: Private sector (Physicians)
[cir] Brief abstract: Form USM-522P must be completed by the OB/GYN
physician of pregnant USMS operational employees to specify any
restrictions from full performance of duties.
--USM-600 Physical Requirements of USMS District Security Officers
[cir] Affected public: Private sector (Physicians)
[cir] Brief abstract: It is the policy of the USMS to ensure a law
enforcement work force that is medically able to safely perform the
required job functions. All applicants for law enforcement positions
must have pre-employment physical examinations. District Security
Officers (DSO) are individual contractors, not employees of USMS; Form
USM-522 does not apply to DSOs.
--CSO-012 Request to Reevaluate Court Security Officer's Medical
Qualification
[cir] Affected public: Private sector (Physicians)
[[Page 22295]]
[cir] Brief abstract: This form is completed by the Court Security
Officer (CSO)'s attending physician to determine whether a CSO is
physically able to return to work after an injury, serious illness, or
surgery. The physician returns the evaluation to the contracting
company, and if the determination is that the CSO may return to work,
the CSO-012 is then signed off on by the contracting company and
forwarded to the USMS for final review by USMS' designated medical
reviewing official. Court Security Officers are contractors, not
employees of USMS; Form USM-522A does not apply to CSOs.
--CSO-229 Certificate of Medical Examination for Court Security
Officers
[cir] Affected public: Private sector (Physicians), Individuals or
households (Applicants to and current employees of the CSO contracting
companies)
[cir] Brief abstract: It is the policy of the USMS to ensure a law
enforcement work force that is medically able to safely perform the
required job functions. All applicants for law enforcement positions
must have pre-employment physical examinations. Court Security Officers
(CSO) are contractors, not employees of USMS; Form USM-522 does not
apply to CSOs.
(5) An estimate of the total number of respondents and the amount
of time estimated for an average respondent to respond:
--USM-522 USMS Physical Examination Report for Operational Employees
It is estimated that 800 respondents will complete a 45 minute
form.
--USM-522A Physician Evaluation Report for USMS Operational Employees
It is estimated that 100 respondents will complete a 20 minute
form.
--USM-522E USMS Medical Update
It is estimated that 100 respondents will complete a 20 minute
form.
--USM-522K Applicant Review of Immunizations
It is estimated that 350 respondents will completed a 10 minute
form.
--USM-522P Physician Evaluation Report for USMS Operational Employees
(Pregnancy Only)
It is estimated that 12 respondents will complete a 15 minute form.
--USM-600 Physical Requirements of USMS District Security Officers
It is estimated that 800 respondents will complete a 20 minute
form.
--CSO-012 Request to Reevaluate Court Security Officer's Medical
Qualification
It is estimated that 300 respondents will complete a 30 minute
form.
--CSO-229 Certificate of Medical Examination for Court Security
Officers
It is estimated that 4300 respondents will complete a 30 minute
form.
(6) An estimate of the total public burden (in hours) associated
with the collection:
--USM-522 USMS Physical Examination Report for Operational Employees
There are an estimated 600 annual total burden hours associated
with this collection.
--USM-522A Physician Evaluation Report for USMS Operational Employees
There are an estimated 33 annual total burden hours associated with
this collection.
--USM-522E USMS Medical Update
There are an estimated 33 annual total burden hours associated with
this collection.
--USM-522 K Applicant Review of Immunizations
There are an estimated 58 annual total burden hours associated with
this collection.
--USM-522P Physician Evaluation Report for USMS Operational Employees
(Pregnancy Only)
There are an estimated 3 annual total burden hours associated with
this collection.
--USM-600 Physical Requirements of USMS District Security Officers
There are an estimated 267 annual total burden hours associated
with this collection.
--CSO-012 Request to Reevaluate Court Security Officer's Medical
Qualification
There are an estimated 150 annual total burden hours associated
with this collection.
--CSO-229 Certificate of Medical Examination for Court Security
Officers
There are an estimated 2,150 annual total burden hours associated
with this collection.
Total Annual Time Burden (Hours): 3,269.
If additional information is required contact: Jerri Murray,
Department Clearance Officer, Policy and Planning Staff, Justice
Management Division, Department of Justice, Two Constitution Square,
145 N Street NE., Room 1407B, Washington, DC 20530.
Dated: April 9, 2013.
Jerri Murray,
Department Clearance Officer for PRA, U.S. Department of Justice.
[FR Doc. 2013-08689 Filed 4-12-13; 8:45 am]
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