Information Collection Request; Submission for OMB Review, 52382-52386 [2020-18575]
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documents in paper format. Such filings
must be submitted by: (1) First class
mail addressed to the Office of the
Secretary of the Commission, U.S.
Nuclear Regulatory Commission,
Washington, DC 20555–0001, Attention:
Rulemaking and Adjudications Staff; or
(2) courier, express mail, or expedited
delivery service to the Office of the
Secretary, 11555 Rockville Pike,
Rockville, Maryland 20852, Attention:
Rulemaking and Adjudications Staff.
Participants filing adjudicatory
documents in this manner are
responsible for serving the document on
all other participants. Filing is
considered complete by first-class mail
as of the time of deposit in the mail, or
by courier, express mail, or expedited
delivery service upon depositing the
document with the provider of the
service. A presiding officer, having
granted an exemption request from
using E-Filing, may require a participant
or party to use E-Filing if the presiding
officer subsequently determines that the
reason for granting the exemption from
use of E-Filing no longer exists.
Documents submitted in adjudicatory
proceedings will appear in the NRC’s
electronic hearing docket which is
available to the public at https://
adams.nrc.gov/ehd, unless excluded
pursuant to an order of the Commission
or the presiding officer. If you do not
have an NRC-issued digital ID certificate
as described above, click ‘‘cancel’’ when
the link requests certificates and you
will be automatically directed to the
NRC’s electronic hearing dockets where
you will be able to access any publicly
available documents in a particular
hearing docket. Participants are
requested not to include personal
privacy information, such as social
security numbers, home addresses, or
personal phone numbers in their filings,
unless an NRC regulation or other law
requires submission of such
information. For example, in some
instances, individuals provide home
addresses in order to demonstrate
proximity to a facility or site. With
respect to copyrighted works, except for
limited excerpts that serve the purpose
of the adjudicatory filings and would
constitute a Fair Use application,
participants are requested not to include
copyrighted materials in their
submission.
For further details with respect to this
action, see the application for license
amendment dated August 13, 2020.
Attorney for licensee: Debbie Hendell,
Managing Attorney, Nuclear Florida
Power & Light Company, Mail Stop:
LAW/JB, 700 Universe Boulevard, Juno
Beach, FL 33408.
NRC Branch Chief: Nancy L. Salgado.
VerDate Sep<11>2014
19:55 Aug 24, 2020
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Dated: August 19, 2020.
For the Nuclear Regulatory Commission.
Booma Venkataraman,
Project Manager, Plant Licensing Branch III,
Division of Operating Reactor Licensing,
Office of Nuclear Reactor Regulation.
[FR Doc. 2020–18585 Filed 8–24–20; 8:45 am]
BILLING CODE 7590–01–P
PEACE CORPS
Information Collection Request;
Submission for OMB Review
Peace Corps.
60-Day notice and request for
comments.
AGENCY:
ACTION:
The Peace Corps will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval. The purpose of
this notice is to allow 60 days for public
comment in the Federal Register
preceding submission to OMB. We are
conducting this process in accordance
with the Paperwork Reduction Act of
1995.
SUMMARY:
Submit comments on or before
October 26, 2020.
ADDRESSES: Comments should be
addressed toVirginia Burke, FOIA/
Privacy Act Officer. Virginia Burke can
be contacted by email at pcfr@
peacecorps.gov. Email comments must
be made in text and not in attachments.
FOR FURTHER INFORMATION CONTACT:
Virginia Burke at the Peace Corps’
address above.
SUPPLEMENTARY INFORMATION:
Title: Durable Medical Equipment
(DME) (PC–2161).
OMB Control Number: 0420–0559.
Type of Request: New information
collection.
Affected Public: Individuals.
Respondents Obligation to Reply:
Voluntary.
Respondents: Potential and current
volunteers.
Burdent to the Public:
a. Estimated number of respondents
(applicants/physicians): 77/77.
b. Estimated average burden per
response: 15 minutes/10 minutes.
c. Frequency of response: One Time.
d. Annual reporting burden: 19 hours/
13 hours.
General Description of Collection:
Durable Medical Equipment (DME) is
any equipment that provides
therapeutic benefits to a patient in need
because of certain medical conditions
and/or illness. They consist of items
that are primarily and customarily used
to serve a medical purpose; are not
DATES:
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useful to a person in the absence of
illness or injury; are ordered or
prescribed by a physician; are reusable;
can stand repeated use, and are
appropriate for use in the home. Other
devices covered in this guidance
include prosthetic equipment (cardiac
pacemakers), hearing aids, orthotic
items (artificial devices such as braces
and splints), and prostheses (artificial
body parts). The information collected
will assist in the determination of Peace
Corps eligibility. If eligible, it will assist
with ongoing care during service. All
applicants to the Peace Corps must have
a medical clearance that will determine
their ability to serve in a particular
country.
Request for Comment: Peace Corps
invites comments on whether the
proposed collections of information are
necessary for proper performance of the
functions of the Peace Corps, including
whether the information will have
practical use; the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the information
to be collected; and, ways to minimize
the burden of the collection of
information on those who are to
respond, including through the use of
automated collection techniques, when
appropriate, and other forms of
information technology.
This notice is issued in Washington, DC,
on August 19, 2020.
Virginia Burke,
FOIA/Privacy Act Officer, Management.
[FR Doc. 2020–18577 Filed 8–24–20; 8:45 am]
BILLING CODE 6051–01–P
PEACE CORPS
Information Collection Request;
Submission for OMB Review
Peace Corps.
60-Day notice and request for
comments.
AGENCY:
ACTION:
The Peace Corps will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval. The purpose of
this notice is to allow 60 days for public
comment in the Federal Register
preceding submission to OMB. We are
conducting this process in accordance
with the Paperwork Reduction Act of
1995.
SUMMARY:
Submit comments on or before
October 26, 2020.
ADDRESSES: Comments should be
addressed to Virginia Burke, FOIA/
Privacy Act Officer. Virginia Burke can
DATES:
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be contacted by email at pcfr@
peacecorps.gov. Email comments must
be made in text and not in attachments.
FOR FURTHER INFORMATION CONTACT:
Virginia Burke at the Peace Corps
address above.
SUPPLEMENTARY INFORMATION:
Title: Individual Specific Medical
Evaluation Forms (15).
OMB Control Number: 0420–0550.
Type of Request: Revision/New.
Affected Public: Individuals/
Physicians.
Respondents Obligation to Reply:
Voluntary.
Respondents: Potential and current
volunteers.
Burden to the Public:
• Asthma Evaluation Form (PC–262–2)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
800/800.
one time.
75 minutes/30 minutes.
1,000 hours/400
hours.
$23,240/$38,740.
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General Description of Collection:
When an Applicant reports on the
Health History Form (PC–1789) any
history of asthma, he or she will be
provided an Asthma Evaluation Form
for the treating physician to complete.
The Asthma Evaluation Form asks for
the physician to document the
Applicant’s condition of asthma,
including any asthma symptoms,
triggers, treatments, or limitations or
restrictions due to the condition. This
form will be used as the basis for an
individualized determination as to
whether the Applicant will, with
reasonable accommodation, be able to
perform the essential functions of a
Peace Corps Volunteer and complete a
tour of service without unreasonable
disruption due to health problems. This
form will also be used to determine the
type of accommodation that may be
needed, such as placement of the
Applicant within reasonable proximity
to a hospital in case treatment is needed
for a severe asthma attack.
• Diabetes Diagnosis Form (PC–262–3)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
VerDate Sep<11>2014
37/37.
one time.
75 minutes/30 minutes.
46 hours/19 hours.
19:55 Aug 24, 2020
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(e) Estimated annual
$1,069/$1,840.15.
cost to respondents.
General Description of Collection:
When an Applicant reports the
condition of diabetes Type 1 on the
Health History Form (PC–1789), the
Applicant will be provided a Diabetes
Diagnosis Form for the treating
physician to complete. In certain cases,
the Applicant may also be asked to have
the treating physician complete a
Diabetes Diagnosis Form if the
Applicant reports the condition of
diabetes Type 2 on the Health History
Form. The Diabetes Diagnosis Form asks
the physician to document the diabetes
diagnosis, etiology, possible
complications, and treatment. This form
will be used as the basis for an
individualized determination as to
whether the Applicant will, with
reasonable accommodation, be able to
perform the essential functions of a
Peace Corps Volunteer assignment and
complete a tour of service without
unreasonable disruption due to health
problems. This form will also be used to
determine the type of accommodation
that may be needed, such as placement
of an Applicant who requires the use of
insulin in order to ensure that adequate
insulin storage facilities are available at
the Applicant’s site.
• Transfer of Care—Request for
Information Form (PC–262–13)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
3,100/3,100.
one time.
75 minutes/30 minutes.
3,875 hours/1,550
hours.
$90,055/$150,117.5.
General Description of Collection:
When an Applicant reports on the
Health History Form (PC–1789) a
medical condition of significant severity
(other than one covered by another
form), he or she may be provided the
Transfer of Care—Request for
Information Form for the treating
physician to complete. The Transfer of
Care—Request for Information Form
may also be provided to an Applicant
whose responses on the Health History
Form indicate that the Applicant may
have an unstable medical condition that
requires ongoing treatment. The
Transfer of Care—Request for
Information Form asks the physician to
document the diagnosis, current
treatment, physical limitations and the
likelihood of significant progression of
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the condition over the next three years.
This form will be used as the basis for
an individualized determination as to
whether the Applicant will, with
reasonable accommodation, be able to
perform the essential functions of a
Peace Corps Volunteer assignment and
complete a tour of service without
unreasonable disruption due to health
problems. This form will also be used to
determine the type of accommodation
(e.g., avoidance of high altitudes or
proximity to a hospital) that may be
needed to manage the Applicant’s
medical condition.
• Mental Health Current Evaluation and
Treatment Summary Form (PC–262–
14)
(a) Estimated number
of Applicants/professional.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
2,500/2,500.
one time.
105 minutes/60 minutes.
4,375 hours/2,500
hours.
$101,675/$24,212.5.
General Description of Collection: The
Mental Health Current Evaluation and
Treatment Form will be used when an
Applicant reports on the Health History
Form (PC–1789) a history of certain
serious mental health conditions, such
as bipolar disorder, schizophrenia,
mental health hospitalization, attempted
suicide or cutting, or treatments or
medications related to these conditions.
In these cases, an Applicant will be
provided a Mental Health Current
Evaluation and Treatment Summary
Form for a licensed mental health
counselor, psychiatrist or psychologist
to complete. The Mental Health Current
Evaluation and Treatment Summary
Form asks the counselor, psychiatrist or
psychologist to document the dates and
frequency of therapy sessions, clinical
diagnoses, symptoms, course of
treatment, psychotropic medications,
mental health history, level of
functioning, prognosis, risk of
exacerbation or recurrence while
overseas, recommendations for follow
up and any concerns that would prevent
the Applicant from completing 27
months of service without unreasonable
disruption. A current mental health
evaluation might be needed if
information on the condition is outdated or previous reports on the
condition do not provide enough
information to adequately assess the
current status of the condition. This
form will be used as the basis for an
individualized determination as to
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whether the Applicant will, with
reasonable accommodation, be able to
perform the essential functions of a
Peace Corps Volunteer and complete a
tour of service without unreasonable
disruption due to health problems. This
form will also be used to determine the
type of accommodation that may be
needed, such as placement of the
Applicant in a country with appropriate
mental health support.
• Functional Abilities Evaluation Form
(PC–262–15)
(a) Estimated number
of Applicants/professional.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
90/90.
one time.
90 minutes/45 minutes.
135/67.5 hours.
$3,137.40/$6,537.37.
General Description of Collection:
When an Applicant reports on the
Health History Form (PC–1789) a
functional ability limitation, he or she
will then be provided this form to
determine the type of accommodation
and/or placement program support (e.g.,
proximity to program site, support
support devices) that may be needed to
manage the Applicant’s medical
condition. This form will be used as the
basis for an individualized
determination as to whether the
Applicant will, with reasonable
accommodation, be able to perform the
essential functions of a Peace Corps
Volunteer assignment and complete a
tour of service without unreasonable
disruption due to health problems.
• Eating Disorder Treatment Summary
Form (PC–262–8)
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(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
110/110.
one time.
105 minutes/60 minutes.
193 hours/110 hours.
$4,485.32/$10,653.5.
General Description of Collection: The
Eating Disorder Treatment Summary
will be used when an Applicant reports
a past or current eating disorder
diagnosis in the Health History Form
(PC–1789). In these cases the Applicant
is provided an Eating Disorder
Treatment Summary Form for a mental
health specialist, preferably with eating
VerDate Sep<11>2014
19:55 Aug 24, 2020
Jkt 250001
disorder training, to complete. The
Eating Disorder Treatment Summary
Form asks the mental health specialist
to document the dates and frequency of
therapy sessions, clinical diagnoses,
presenting problems and precipitating
factors, symptoms, Applicant’s weight
over the past three years, relevant family
history, course of treatment,
psychotropic medications, mental
health history inclusive of eating
disorder behaviors, level of functioning,
prognosis, risk of recurrence in a
stressful overseas environment,
recommendations for follow up, and
any concerns that would prevent the
Applicant from completing 27 months
of service without unreasonable
disruption due to the diagnosis. This
form will be used as the basis for an
individualized determination as to
whether the Applicant will, with
reasonable accommodation, be able to
perform the essential functions of a
Peace Corps Volunteer assignment and
complete a tour of service without
unreasonable disruption due to health
problems. This form will also be used to
determine the type of accommodation
that may be needed, such as placement
of the Applicant in a country with
appropriate mental health support.
• Substance-Related and Addictive
Disorders Current Evaluation Form
(PC–262–6)
(a) Estimated number
of Applicants/specialist.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
90/90.
one time.
165 minutes/60 minutes.
248 hours/90 hours.
$5,763.52/$8,716.5.
General Description of Collection: The
Substance-Related and Addictive
Disorders Current Evaluation Form is
used when an Applicant reports in the
Health History Form (PC–1789) a
history of substance abuse (i.e., alcohol
or drug related problems such as
blackouts, daily or heavy drinking
patterns or the misuse of illegal or
prescription drugs) and that this
substance abuse affects the Applicant’s
daily living or that the Applicant has
ongoing symptoms of substance abuse.
In these cases, the Applicant is provided
an Substance-Related and Addictive
Disorders Current Evaluation Form for a
substance abuse specialist to complete.
The Substance-Related and Addictive
Disorders Current Evaluation Form asks
the substance abuse specialist to
document the history of alcohol/
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substance abuse, dates and frequency of
any therapy sessions, which alcohol/
substance abuse assessment tools were
administered, mental health diagnoses,
psychotropic medications, self harm
behavior, current clinical assessment of
alcohol/substance use, clinical
observations, risk of recurrence in a
stressful overseas environment,
recommendations for follow up, and
any concerns that would prevent the
Applicant from completing a tour of
service without unreasonable disruption
due to the diagnosis. This form will be
used as the basis for an individualized
determination as to whether the
Applicant will, with reasonable
accommodation, be able to perform the
essential functions of a Peace Corps
Volunteer and complete a tour of service
without unreasonable disruption due to
health problems. This form will also be
used to determine the type of
accommodation that may be needed,
such as placement of the Applicant in
a country with appropriate sobriety
support or counseling support.
• Mammogram Waiver Form (PC–355–
2)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
190.
one time.
105 minutes.
333.
$7,738.92.
General Description of Collection: The
Mammogram Waiver Form is used for
all Applicants who have female breasts
and will be 50 years of age or older
during service who wish to waive
routine mammogram screening during
service. If an Applicant waives routine
mammogram screening during service,
the Applicant’s physician is asked to
complete this form in order to make a
general assessment of the Applicant’s
statistical breast cancer risk and
discussed the results with the Applicant
including the potential adverse health
consequence of foregoing screening
mammography. It is anticipated that this
part of the form will be completed when
the Applicant goes to a physician for the
required physical examination.
• Cervical Cancer Screening Form (PC–
262–11)
(a) Estimated number
of Applicants.
(b) Frequency of response.
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one time.
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(c) Estimated average 40 minutes/30 minburden per reutes.
sponse.
(d) Estimated total re- 3,067 hours/2,300
porting burden.
hours.
(e) Estimated annual
$71,277.08/
cost to respondents.
$22,275.5.
General Description of Collection: The
Cervical Cancer Screening Form is used
with all Applicants with a cervix. Prior
to medical clearance, female Applicants
are required to submit a current cervical
cancer screening examination and Pap
cytology report based the American
Society for Colploscopy and Cervical
Pathology (ASCCP) screening time-line
for their age and Pap history. This form
assists the Peace Corps in determining
whether an Applicant with mildly
abnormal Pap history will need to be
placed in a country with appropriate
support.
• Colon Cancer Screening Form
(a) Estimated number
of Applicants.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
450.
60–165 minutes.
450–1,238 hours.
$10,458.
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476/467.
one time.
25 minutes/15 minutes.
198 hours/119 hours.
$4,601.52/
$11,525.15.
General Description of Collection: The
Electrocardiogram (ECG/EKG) Form is
VerDate Sep<11>2014
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
109/109.
one time.
75–105 minutes/30
minutes.
136–191 hours/55
hours.
$3,160.64–$4,438.84/
$5,326.75.
one time.
General Description of Collection: The
Colon Cancer Screening Form is used
with all Applicants who are 50 years of
age or older to provide the Peace Corps
with the results of the Applicant’s latest
colon cancer screening. Any testing
deemed appropriate by the American
Cancer Society is accepted. The Peace
Corps uses the information in the Colon
Cancer Screening Form to determine if
the Applicant currently has colon
cancer. Additional instructions are
included pertaining to abnormal test
results. It is anticipated that this part of
the form will be completed when the
Applicant goes to a physician for the
required physical examination.
• Electrocardiogram (ECG/EKG) Form
(PC–262–7)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
used with all Applicants who are 50
years of age or older to provide the
Peace Corps with the results of an
electrocardiogram. The Peace Corps
uses the information in the
electrocardiogram to assess whether the
Applicant has any cardiac abnormalities
that might affect the Applicant’s service.
Additional instructions are included
pertaining to abnormal test results. The
electrocardiogram is performed as part
of the Applicant’s physical examination.
• Reactive Tuberculin Test Evaluation
Form (PC–262–12)
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General Description of Collection: The
Reactive Tuberculin Test Evaluation
Form is used when an Applicant reports
a history of treatment for active
tuberculosis or a history of a positive
tuberculosis (TB) test on their Health
History Form (PC–1789) or if a positive
TB test result is noted as a component
of the Applicant’s physical examination
findings. In these cases, the Applicant is
provided a Reactive Tuberculin Test
Evaluation Form for the treating
physician to complete. The treating
physician is asked to document the type
and date of a current TB test, TB test
history, diagnostic tests if indicated,
treatment history, risk assessment for
developing active TB, current TB
symptoms, and recommendations for
further evaluation and treatment. In the
case of a positive result on the TB test,
a chest x-ray may be required, along
with treatment for latent TB.
• Insulin Dependent Supplemental
Documentation Form (PC–262–10)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
9/9.
one time.
70 minutes/60 minutes.
11 hours/9 hours.
$255.64/$871.65.
General Description of Collection: The
Insulin Dependent Supplemental
Documentation Form is used with
Applicants who have reported on the
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Health History Form (PC–1789) that
they have insulin dependent diabetes.
In these cases, the Applicant is provided
an Insulin Dependent Supplemental
Documentation Form for the treating
physician to complete. The Insulin
Dependent Supplemental
Documentation Form asks the treating
physician to document that he or she
has discussed with the Applicant
medication (insulin) management,
including whether an insulin pump is
required, as well as the care and
maintenance of all required diabetes
related monitors and equipment. This
form assists the Peace Corps in
determining whether the Applicant will
be in need of insulin storage while in
service and, if so, will assist the Peace
Corps in determining an appropriate
placement for the Applicant.
• Prescription for Eyeglasses Form (PC–
OMS–116)
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
3,750/3,750.
one time.
60 minutes/15 minutes.
3,750 hours/938
hours.
$8,7150/$90,845.30.
General Description of Collection: The
Prescription for Eyeglasses Form is used
with Applicants who have reported on
the Health History Form (PC–1789) that
they use corrective lenses or otherwise
have uncorrected vision that is worse
than 20/40. In these cases, Applicants
are provided a Prescription for
Eyeglasses Form for their prescriber to
indicate eyeglasses frame
measurements, lens instructions, type of
lens, gross vision and any special
instructions. This form is used in order
to enable the Peace Corps to obtain
replacement eyeglasses for a Volunteer
during service.
• Required Peace Corps Immunizations
Form
(a) Estimated number
of Applicants/physicians.
(b) Frequency of response.
(c) Estimated average
burden per response.
(d) Estimated total reporting burden.
(e) Estimated annual
cost to respondents.
5,100.
one time.
60 minutes.
5,100 hours.
$11,8524.
General Description of Collection: The
Required Peace Corps Immunizations
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Form is used to informed Applicants of
the specific vaccines and/or
documented proof of immunity required
for medical clearance for the specific
country of service. The form advises the
Applicant that all other Center for
Disease Control (CDC) recommended
vaccinations will be administered after
arrival in-country. This form assists the
Peace Corps with establishing a baseline
of the Applicants immunization history
and prepare for any additional vaccines
recommended for country of service. It
is anticipated that this part of the form
will be completed when the Applicant
goes to a physician for the required
physical examination.
Request for Comment: The Peace
Corps invites comments on whether the
proposed collections of information are
necessary for proper performance of the
functions of the Peace Corps, including
whether the information will have
practical use; the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the information
to be collected; and, ways to minimize
the burden of the collection of
information on those who are to
respond, including through the use of
automated collection techniques, when
appropriate, and other forms of
information technology.
This notice is issued in Washington, DC,
on August 19, 2020.
Virginia Burke,
FOIA/Privacy Act Specialist, Management.
[FR Doc. 2020–18575 Filed 8–24–20; 8:45 am]
BILLING CODE 6051–01–P
PEACE CORPS
Information Collection Request;
Submission for OMB Review
Peace Corps.
60-Day notice and request for
comments.
AGENCY:
ACTION:
The Peace Corps will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval. The purpose of
this notice is to allow 60 days for public
comment in the Federal Register
preceding submission to OMB. We are
conducting this process in accordance
with the Paperwork Reduction Act of
1995.
khammond on DSKJM1Z7X2PROD with NOTICES
SUMMARY:
Submit comments on or before
October 26, 2020.
ADDRESSES: Comments should be
addressed toVirginia Burke, FOIA/
Privacy Act Officer. Virginia Burke can
be contacted by email at pcfr@
peacecorps.gov. Email comments must
be made in text and not in attachments.
FOR FURTHER INFORMATION CONTACT:
Virginia Burke at the Peace Corps
address above.
SUPPLEMENTARY INFORMATION:
Title: Report of Dental Examination
(PC–1790).
OMB Control Number: 0420–0546.
Type of Request: Revision.
Affected Public: Individuals/
Physicians.
Respondents Obligation to Reply:
Voluntary.
Respondents: Potential and current
volunteers.
Burden to the Public:
a. Estimated number of respondents
(applicants/dentists): 7,000/7,000.
b. Estimated average burden per
response (applicants/dentists): 90
minutes/45 minutes.
c. Frequency of response: One time.
d. Annual reporting burden
(applicants/dentists): 10,500/5,250.
General Description of Collection: The
Peace Corps Office of Medical Services
is responsible for the collection of
Applicant dental information, using the
Report of Dental Exam ‘‘Dental Exam’’
form. The Dental Exam form is
completed by the Applicant’s examining
dentist. The results of the examinations
are used to ensure that Applicants for
Volunteer service will, with reasonable
accommodation, be able to serve in the
Peace Corps without jeopardizing their
health.
Request for Comment: Peace Corps
invites comments on whether the
proposed collections of information are
necessary for proper performance of the
functions of the Peace Corps, including
whether the information will have
practical use; the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the information
to be collected; and, ways to minimize
the burden of the collection of
information on those who are to
respond, including through the use of
automated collection techniques, when
appropriate, and other forms of
information technology.
This notice is issued in Washington, DC,
on August 19, 2020.
Virginia Burke,
FOIA/Privacy Act Officer, Management.
[FR Doc. 2020–18576 Filed 8–24–20; 8:45 am]
BILLING CODE 6051–01–P
DATES:
VerDate Sep<11>2014
19:55 Aug 24, 2020
Jkt 250001
PEACE CORPS
Information Collection Request;
Submission for OMB Review
AGENCY:
PO 00000
Peace Corps.
Frm 00087
Fmt 4703
Sfmt 4703
60-Day notice and request for
comments.
ACTION:
The Peace Corps will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval. The purpose of
this notice is to allow 60 days for public
comment in the Federal Register
preceding submission to OMB. We are
conducting this process in accordance
with the Paperwork Reduction Act of
1995.
SUMMARY:
Submit comments on or before
October 26, 2020.
ADDRESSES: Comments should be
addressed to Virginia Burke, FOIA/
Privacy Act Officer. Virginia Burke can
be contacted by email at pcfr@
peacecorps.gov. Email comments must
be made in text and not in attachments.
FOR FURTHER INFORMATION CONTACT:
Virginia Burke at the Peace Corps
address above.
SUPPLEMENTARY INFORMATION:
Title: Health History Form (PC–1789).
OMB Control Number: 0420–0510.
Type of Request: Revison.
Affected Public: Individuals.
Respondents Obligation to Reply:
Voluntary.
Respondents: Potential and current
Volunteers.
Burden to the Public:
a. Estimated number of respondents
(applicants/physicians): 13,350.
b. Estimated average burden per
response: 45 minutes.
c. Frequency of response: One Time.
d. Annual reporting burden: 10,013.
General Description of Collection: The
information collected is required for
consideration for Peace Corps Volunteer
service. The information in the Health
History Form, will be used by the Peace
Corps Office of Medical Services to
determine whether an Applicant will,
with reasonable accommodation, be able
to perform the essential functions of a
Peace Corps Volunteer and complete a
tour of service without undue
disruption due to health problems and,
if so, to establish the level of medical
and programmatic support, if any, that
may be required to reasonably
accommodate the Applicant.
Request for Comment: Peace Corps
invites comments on whether the
proposed collections of information are
necessary for proper performance of the
functions of the Peace Corps, including
whether the information will have
practical use; the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the information
to be collected; and, ways to minimize
DATES:
E:\FR\FM\25AUN1.SGM
25AUN1
]]>Agencies
[Federal Register Volume 85, Number 165 (Tuesday, August 25, 2020)]
[Notices]
[Pages 52382-52386]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-18575]
-----------------------------------------------------------------------
PEACE CORPS
Information Collection Request; Submission for OMB Review
AGENCY: Peace Corps.
ACTION: 60-Day notice and request for comments.
-----------------------------------------------------------------------
SUMMARY: The Peace Corps will be submitting the following information
collection request to the Office of Management and Budget (OMB) for
review and approval. The purpose of this notice is to allow 60 days for
public comment in the Federal Register preceding submission to OMB. We
are conducting this process in accordance with the Paperwork Reduction
Act of 1995.
DATES: Submit comments on or before October 26, 2020.
ADDRESSES: Comments should be addressed to Virginia Burke, FOIA/Privacy
Act Officer. Virginia Burke can
[[Page 52383]]
be contacted by email at [email protected]. Email comments must be
made in text and not in attachments.
FOR FURTHER INFORMATION CONTACT: Virginia Burke at the Peace Corps
address above.
SUPPLEMENTARY INFORMATION:
Title: Individual Specific Medical Evaluation Forms (15).
OMB Control Number: 0420-0550.
Type of Request: Revision/New.
Affected Public: Individuals/Physicians.
Respondents Obligation to Reply: Voluntary.
Respondents: Potential and current volunteers.
Burden to the Public:
Asthma Evaluation Form (PC-262-2)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 800/800.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 75 minutes/30 minutes.
(d) Estimated total reporting burden...... 1,000 hours/400 hours.
(e) Estimated annual cost to respondents.. $23,240/$38,740.
------------------------------------------------------------------------
General Description of Collection: When an Applicant reports on the
Health History Form (PC-1789) any history of asthma, he or she will be
provided an Asthma Evaluation Form for the treating physician to
complete. The Asthma Evaluation Form asks for the physician to document
the Applicant's condition of asthma, including any asthma symptoms,
triggers, treatments, or limitations or restrictions due to the
condition. This form will be used as the basis for an individualized
determination as to whether the Applicant will, with reasonable
accommodation, be able to perform the essential functions of a Peace
Corps Volunteer and complete a tour of service without unreasonable
disruption due to health problems. This form will also be used to
determine the type of accommodation that may be needed, such as
placement of the Applicant within reasonable proximity to a hospital in
case treatment is needed for a severe asthma attack.
Diabetes Diagnosis Form (PC-262-3)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 37/37.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 75 minutes/30 minutes.
(d) Estimated total reporting burden...... 46 hours/19 hours.
(e) Estimated annual cost to respondents.. $1,069/$1,840.15.
------------------------------------------------------------------------
General Description of Collection: When an Applicant reports the
condition of diabetes Type 1 on the Health History Form (PC-1789), the
Applicant will be provided a Diabetes Diagnosis Form for the treating
physician to complete. In certain cases, the Applicant may also be
asked to have the treating physician complete a Diabetes Diagnosis Form
if the Applicant reports the condition of diabetes Type 2 on the Health
History Form. The Diabetes Diagnosis Form asks the physician to
document the diabetes diagnosis, etiology, possible complications, and
treatment. This form will be used as the basis for an individualized
determination as to whether the Applicant will, with reasonable
accommodation, be able to perform the essential functions of a Peace
Corps Volunteer assignment and complete a tour of service without
unreasonable disruption due to health problems. This form will also be
used to determine the type of accommodation that may be needed, such as
placement of an Applicant who requires the use of insulin in order to
ensure that adequate insulin storage facilities are available at the
Applicant's site.
Transfer of Care--Request for Information Form (PC-262-13)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 3,100/3,100.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 75 minutes/30 minutes.
(d) Estimated total reporting burden...... 3,875 hours/1,550 hours.
(e) Estimated annual cost to respondents.. $90,055/$150,117.5.
------------------------------------------------------------------------
General Description of Collection: When an Applicant reports on the
Health History Form (PC-1789) a medical condition of significant
severity (other than one covered by another form), he or she may be
provided the Transfer of Care--Request for Information Form for the
treating physician to complete. The Transfer of Care--Request for
Information Form may also be provided to an Applicant whose responses
on the Health History Form indicate that the Applicant may have an
unstable medical condition that requires ongoing treatment. The
Transfer of Care--Request for Information Form asks the physician to
document the diagnosis, current treatment, physical limitations and the
likelihood of significant progression of the condition over the next
three years. This form will be used as the basis for an individualized
determination as to whether the Applicant will, with reasonable
accommodation, be able to perform the essential functions of a Peace
Corps Volunteer assignment and complete a tour of service without
unreasonable disruption due to health problems. This form will also be
used to determine the type of accommodation (e.g., avoidance of high
altitudes or proximity to a hospital) that may be needed to manage the
Applicant's medical condition.
Mental Health Current Evaluation and Treatment Summary Form
(PC-262-14)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 2,500/2,500.
professional.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 105 minutes/60 minutes.
(d) Estimated total reporting burden...... 4,375 hours/2,500 hours.
(e) Estimated annual cost to respondents.. $101,675/$24,212.5.
------------------------------------------------------------------------
General Description of Collection: The Mental Health Current
Evaluation and Treatment Form will be used when an Applicant reports on
the Health History Form (PC-1789) a history of certain serious mental
health conditions, such as bipolar disorder, schizophrenia, mental
health hospitalization, attempted suicide or cutting, or treatments or
medications related to these conditions. In these cases, an Applicant
will be provided a Mental Health Current Evaluation and Treatment
Summary Form for a licensed mental health counselor, psychiatrist or
psychologist to complete. The Mental Health Current Evaluation and
Treatment Summary Form asks the counselor, psychiatrist or psychologist
to document the dates and frequency of therapy sessions, clinical
diagnoses, symptoms, course of treatment, psychotropic medications,
mental health history, level of functioning, prognosis, risk of
exacerbation or recurrence while overseas, recommendations for follow
up and any concerns that would prevent the Applicant from completing 27
months of service without unreasonable disruption. A current mental
health evaluation might be needed if information on the condition is
out-dated or previous reports on the condition do not provide enough
information to adequately assess the current status of the condition.
This form will be used as the basis for an individualized determination
as to
[[Page 52384]]
whether the Applicant will, with reasonable accommodation, be able to
perform the essential functions of a Peace Corps Volunteer and complete
a tour of service without unreasonable disruption due to health
problems. This form will also be used to determine the type of
accommodation that may be needed, such as placement of the Applicant in
a country with appropriate mental health support.
Functional Abilities Evaluation Form (PC-262-15)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 90/90.
professional.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 90 minutes/45 minutes.
(d) Estimated total reporting burden...... 135/67.5 hours.
(e) Estimated annual cost to respondents.. $3,137.40/$6,537.37.
------------------------------------------------------------------------
General Description of Collection: When an Applicant reports on the
Health History Form (PC-1789) a functional ability limitation, he or
she will then be provided this form to determine the type of
accommodation and/or placement program support (e.g., proximity to
program site, support support devices) that may be needed to manage the
Applicant's medical condition. This form will be used as the basis for
an individualized determination as to whether the Applicant will, with
reasonable accommodation, be able to perform the essential functions of
a Peace Corps Volunteer assignment and complete a tour of service
without unreasonable disruption due to health problems.
Eating Disorder Treatment Summary Form (PC-262-8)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 110/110.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 105 minutes/60 minutes.
(d) Estimated total reporting burden...... 193 hours/110 hours.
(e) Estimated annual cost to respondents.. $4,485.32/$10,653.5.
------------------------------------------------------------------------
General Description of Collection: The Eating Disorder Treatment
Summary will be used when an Applicant reports a past or current eating
disorder diagnosis in the Health History Form (PC-1789). In these cases
the Applicant is provided an Eating Disorder Treatment Summary Form for
a mental health specialist, preferably with eating disorder training,
to complete. The Eating Disorder Treatment Summary Form asks the mental
health specialist to document the dates and frequency of therapy
sessions, clinical diagnoses, presenting problems and precipitating
factors, symptoms, Applicant's weight over the past three years,
relevant family history, course of treatment, psychotropic medications,
mental health history inclusive of eating disorder behaviors, level of
functioning, prognosis, risk of recurrence in a stressful overseas
environment, recommendations for follow up, and any concerns that would
prevent the Applicant from completing 27 months of service without
unreasonable disruption due to the diagnosis. This form will be used as
the basis for an individualized determination as to whether the
Applicant will, with reasonable accommodation, be able to perform the
essential functions of a Peace Corps Volunteer assignment and complete
a tour of service without unreasonable disruption due to health
problems. This form will also be used to determine the type of
accommodation that may be needed, such as placement of the Applicant in
a country with appropriate mental health support.
Substance-Related and Addictive Disorders Current Evaluation
Form (PC-262-6)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 90/90.
specialist.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 165 minutes/60 minutes.
(d) Estimated total reporting burden...... 248 hours/90 hours.
(e) Estimated annual cost to respondents.. $5,763.52/$8,716.5.
------------------------------------------------------------------------
General Description of Collection: The Substance-Related and
Addictive Disorders Current Evaluation Form is used when an Applicant
reports in the Health History Form (PC-1789) a history of substance
abuse (i.e., alcohol or drug related problems such as blackouts, daily
or heavy drinking patterns or the misuse of illegal or prescription
drugs) and that this substance abuse affects the Applicant's daily
living or that the Applicant has ongoing symptoms of substance abuse.
In these cases, the Applicant is provided an Substance-Related and
Addictive Disorders Current Evaluation Form for a substance abuse
specialist to complete. The Substance-Related and Addictive Disorders
Current Evaluation Form asks the substance abuse specialist to document
the history of alcohol/substance abuse, dates and frequency of any
therapy sessions, which alcohol/substance abuse assessment tools were
administered, mental health diagnoses, psychotropic medications, self
harm behavior, current clinical assessment of alcohol/substance use,
clinical observations, risk of recurrence in a stressful overseas
environment, recommendations for follow up, and any concerns that would
prevent the Applicant from completing a tour of service without
unreasonable disruption due to the diagnosis. This form will be used as
the basis for an individualized determination as to whether the
Applicant will, with reasonable accommodation, be able to perform the
essential functions of a Peace Corps Volunteer and complete a tour of
service without unreasonable disruption due to health problems. This
form will also be used to determine the type of accommodation that may
be needed, such as placement of the Applicant in a country with
appropriate sobriety support or counseling support.
Mammogram Waiver Form (PC-355-2)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 190.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 105 minutes.
(d) Estimated total reporting burden...... 333.
(e) Estimated annual cost to respondents.. $7,738.92.
------------------------------------------------------------------------
General Description of Collection: The Mammogram Waiver Form is
used for all Applicants who have female breasts and will be 50 years of
age or older during service who wish to waive routine mammogram
screening during service. If an Applicant waives routine mammogram
screening during service, the Applicant's physician is asked to
complete this form in order to make a general assessment of the
Applicant's statistical breast cancer risk and discussed the results
with the Applicant including the potential adverse health consequence
of foregoing screening mammography. It is anticipated that this part of
the form will be completed when the Applicant goes to a physician for
the required physical examination.
Cervical Cancer Screening Form (PC-262-11)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants........ 4,600/4,600.
(b) Frequency of response................. one time.
[[Page 52385]]
(c) Estimated average burden per response. 40 minutes/30 minutes.
(d) Estimated total reporting burden...... 3,067 hours/2,300 hours.
(e) Estimated annual cost to respondents.. $71,277.08/$22,275.5.
------------------------------------------------------------------------
General Description of Collection: The Cervical Cancer Screening
Form is used with all Applicants with a cervix. Prior to medical
clearance, female Applicants are required to submit a current cervical
cancer screening examination and Pap cytology report based the American
Society for Colploscopy and Cervical Pathology (ASCCP) screening time-
line for their age and Pap history. This form assists the Peace Corps
in determining whether an Applicant with mildly abnormal Pap history
will need to be placed in a country with appropriate support.
Colon Cancer Screening Form
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants........ 450.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 60-165 minutes.
(d) Estimated total reporting burden...... 450-1,238 hours.
(e) Estimated annual cost to respondents.. $10,458.
------------------------------------------------------------------------
General Description of Collection: The Colon Cancer Screening Form
is used with all Applicants who are 50 years of age or older to provide
the Peace Corps with the results of the Applicant's latest colon cancer
screening. Any testing deemed appropriate by the American Cancer
Society is accepted. The Peace Corps uses the information in the Colon
Cancer Screening Form to determine if the Applicant currently has colon
cancer. Additional instructions are included pertaining to abnormal
test results. It is anticipated that this part of the form will be
completed when the Applicant goes to a physician for the required
physical examination.
Electrocardiogram (ECG/EKG) Form (PC-262-7)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 476/467.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 25 minutes/15 minutes.
(d) Estimated total reporting burden...... 198 hours/119 hours.
(e) Estimated annual cost to respondents.. $4,601.52/$11,525.15.
------------------------------------------------------------------------
General Description of Collection: The Electrocardiogram (ECG/EKG)
Form is used with all Applicants who are 50 years of age or older to
provide the Peace Corps with the results of an electrocardiogram. The
Peace Corps uses the information in the electrocardiogram to assess
whether the Applicant has any cardiac abnormalities that might affect
the Applicant's service. Additional instructions are included
pertaining to abnormal test results. The electrocardiogram is performed
as part of the Applicant's physical examination.
Reactive Tuberculin Test Evaluation Form (PC-262-12)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 109/109.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 75-105 minutes/30 minutes.
(d) Estimated total reporting burden...... 136-191 hours/55 hours.
(e) Estimated annual cost to respondents.. $3,160.64-$4,438.84/
$5,326.75.
------------------------------------------------------------------------
General Description of Collection: The Reactive Tuberculin Test
Evaluation Form is used when an Applicant reports a history of
treatment for active tuberculosis or a history of a positive
tuberculosis (TB) test on their Health History Form (PC-1789) or if a
positive TB test result is noted as a component of the Applicant's
physical examination findings. In these cases, the Applicant is
provided a Reactive Tuberculin Test Evaluation Form for the treating
physician to complete. The treating physician is asked to document the
type and date of a current TB test, TB test history, diagnostic tests
if indicated, treatment history, risk assessment for developing active
TB, current TB symptoms, and recommendations for further evaluation and
treatment. In the case of a positive result on the TB test, a chest x-
ray may be required, along with treatment for latent TB.
Insulin Dependent Supplemental Documentation Form (PC-262-10)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 9/9.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 70 minutes/60 minutes.
(d) Estimated total reporting burden...... 11 hours/9 hours.
(e) Estimated annual cost to respondents.. $255.64/$871.65.
------------------------------------------------------------------------
General Description of Collection: The Insulin Dependent
Supplemental Documentation Form is used with Applicants who have
reported on the Health History Form (PC-1789) that they have insulin
dependent diabetes. In these cases, the Applicant is provided an
Insulin Dependent Supplemental Documentation Form for the treating
physician to complete. The Insulin Dependent Supplemental Documentation
Form asks the treating physician to document that he or she has
discussed with the Applicant medication (insulin) management, including
whether an insulin pump is required, as well as the care and
maintenance of all required diabetes related monitors and equipment.
This form assists the Peace Corps in determining whether the Applicant
will be in need of insulin storage while in service and, if so, will
assist the Peace Corps in determining an appropriate placement for the
Applicant.
Prescription for Eyeglasses Form (PC-OMS-116)
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 3,750/3,750.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 60 minutes/15 minutes.
(d) Estimated total reporting burden...... 3,750 hours/938 hours.
(e) Estimated annual cost to respondents.. $8,7150/$90,845.30.
------------------------------------------------------------------------
General Description of Collection: The Prescription for Eyeglasses
Form is used with Applicants who have reported on the Health History
Form (PC-1789) that they use corrective lenses or otherwise have
uncorrected vision that is worse than 20/40. In these cases, Applicants
are provided a Prescription for Eyeglasses Form for their prescriber to
indicate eyeglasses frame measurements, lens instructions, type of
lens, gross vision and any special instructions. This form is used in
order to enable the Peace Corps to obtain replacement eyeglasses for a
Volunteer during service.
Required Peace Corps Immunizations Form
------------------------------------------------------------------------
------------------------------------------------------------------------
(a) Estimated number of Applicants/ 5,100.
physicians.
(b) Frequency of response................. one time.
(c) Estimated average burden per response. 60 minutes.
(d) Estimated total reporting burden...... 5,100 hours.
(e) Estimated annual cost to respondents.. $11,8524.
------------------------------------------------------------------------
General Description of Collection: The Required Peace Corps
Immunizations
[[Page 52386]]
Form is used to informed Applicants of the specific vaccines and/or
documented proof of immunity required for medical clearance for the
specific country of service. The form advises the Applicant that all
other Center for Disease Control (CDC) recommended vaccinations will be
administered after arrival in-country. This form assists the Peace
Corps with establishing a baseline of the Applicants immunization
history and prepare for any additional vaccines recommended for country
of service. It is anticipated that this part of the form will be
completed when the Applicant goes to a physician for the required
physical examination.
Request for Comment: The Peace Corps invites comments on whether
the proposed collections of information are necessary for proper
performance of the functions of the Peace Corps, including whether the
information will have practical use; the accuracy of the agency's
estimate of the burden of the proposed collection of information,
including the validity of the information to be collected; and, ways to
minimize the burden of the collection of information on those who are
to respond, including through the use of automated collection
techniques, when appropriate, and other forms of information
technology.
This notice is issued in Washington, DC, on August 19, 2020.
Virginia Burke,
FOIA/Privacy Act Specialist, Management.
[FR Doc. 2020-18575 Filed 8-24-20; 8:45 am]
BILLING CODE 6051-01-P
