Agency Information Collection Activities; Proposals, Submissions, and Approvals: Medical History and Examination

30-Day Notice of Proposed Information Collection: Medical History and Examination

DATES:

Submit comments up to April 9, 2026.

SUPPLEMENTARY INFORMATION:

• Title of Information Collection: Medical History and Examination.

• OMB Control Number: 1405-0068.

• Type of Request: Revision of a Currently Approved Collection.

• Originating Office: Bureau of Medical Services-Office of Medical Clearances (MED/CP/CS/CL).

• Form Number: DS-1843 and DS-1622.

• Respondents: Chief of Mission personnel and eligible family members.

• Estimated Number of Respondents: 2,039.

• Estimated Number of Responses: 2,039.

• Average Time per Response: 1 hour.

• Total Estimated Burden Time: 2,0390 hours.

• Frequency: Upon application/employment for an overseas position and then intermittent, as needed.

• Obligation to Respond: Required to Obtain or Retain a Benefit.

We are soliciting public comments to permit the Department to:

• Evaluate whether the proposed information collection is necessary for the proper functions of the Department.
• 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.
• Enhance the quality, utility, and clarity of the information to be collected.
• 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.