[Federal Register Volume 77, Number 130 (Friday, July 6, 2012)]
[Pages 39986-39987]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-16505]



Forest Service

Information Collection; Health Screening Questionnaire

AGENCY: Forest Service, USDA.

ACTION: Notice; request for comment.


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.

    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 
    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 
    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 
    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]