81 FR 81179 - Information Collection Request Submission for OMB Review
PEACE CORPS Federal Register Volume 81, Issue 222 (November 17, 2016)
Federal Register Volume 81, Issue 222 (November 17, 2016)
| Page Range | 81179-81182 | |
| FR Document | 2016-27565 |
[Federal Register Volume 81, Number 222 (Thursday, November 17, 2016)] [Notices] [Pages 81179-81182] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-27565] ======================================================================= ----------------------------------------------------------------------- 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 (44 U.S.C. Chapter 35). DATES: Submit comments on or before January 17, 2017. ADDRESSES: Comments should be addressed to Denora Miller, FOIA/Privacy Act Officer. Denora Miller can be contacted by telephone at 202-692- 1236 or email at [email protected]. Email comments must be made in text and not in attachments. FOR FURTHER INFORMATION CONTACT: Denora Miller at 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 700/700. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 75 minutes/30 minutes. response. (d) Estimated total reporting burden. 875 hours/350 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: When an Applicant reports on the Health History Form 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 55/55. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 75 minutes/30 minutes. response. (d) Estimated total reporting burden. 69 hours/28 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: When an Applicant reports the condition of diabetes Type 1 on the Health History Form, 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 [[Page 81180]] 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 1270/1270. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 75 minutes/30 minutes. response. (d) Estimated total reporting burden. 1588 hours/635 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: When an Applicant reports on the Health History Form 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 1221/1221. professional. (b) Frequency of response............ one time. (c) Estimated average burden per 105 minutes/60 minutes. response. (d) Estimated total reporting burden. 2137 hours/1221 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Mental Health Current Evaluation Form will be used when an Applicant reports on the Health History Form 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 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 300/300. professional. (b) Frequency of response............ one time. (c) Estimated average burden per 90 minutes/45 minutes. response. (d) Estimated total reporting burden. 390 hours/225 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: When an Applicant reports on the Health History Form a functional ability limitation he or she will 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 282/282. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 105 minutes/60 minutes. response. (d) Estimated total reporting burden. 494 hours/282 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ 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. 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 373/373. specialist. (b) Frequency of response............ one time. (c) Estimated average burden per minutes. response165 minutes/60. (d) Estimated total reporting . burden1026 hours/373 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Alcohol/Substance Abuse Current [[Page 81181]] Evaluation Form is used when an Applicant reports in the Health History Form 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants... 148. (b) Frequency of response............ one time. (c) Estimated average burden per 105 minutes. response. (d) Estimated total reporting burden. 259 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Mammogram 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. ------------------------------------------------------------------------ ------------------------------------------------------------------------ Cervical Cancer Screening Form ------------------------------------------------------------------------ (a) Estimated number of Applicants... 3600/3600. (b) Frequency of response............ one time. (c) Estimated average burden per 40 minutes/30 minutes. response. (d) Estimated total reporting burden. 2400 hours/1800 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ 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... 575. (b) Frequency of response............ one time. (c) Estimated average burden per 60 minutes--165 minutes. response. (d) Estimated total reporting burden. 575 hours--1581 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ 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. ------------------------------------------------------------------------ ------------------------------------------------------------------------ ECG Form ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 575/575. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 25 minutes/15 minutes. response. (d) Estimated total reporting burden. 240 hours/144 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 392/392. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 75-105 minutes/30 minutes. response. (d) Estimated total reporting burden. 490-686 hours/196 hours. (e) Estimated annual cost to respondents Indeterminate. ------------------------------------------------------------------------ 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 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 14/14. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 70 minutes/60 minutes. response. (d) Estimated total reporting burden. 16 hours/14 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Insulin Dependent Supplemental Documentation Form is used with Applicants who have reported on the Health History Form 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, [[Page 81182]] 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 ------------------------------------------------------------------------ (a) Estimated number of Applicants/ 3,293/3,293. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 60 minutes/15 minutes. response. (d) Estimated total reporting burden. 3,293 hours/824 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Prescription for Eyeglasses is used with Applicants who have reported on the Health History Form 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/ 5,600. physicians. (b) Frequency of response............ one time. (c) Estimated average burden per 60 minutes. response. (d) Estimated total reporting burden. 5,600 hours. (e) Estimated annual cost to Indeterminate. respondents. ------------------------------------------------------------------------ General Description of Collection: The Required Peace Corps Immunizations 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. 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 November 8, 2016. Monique Harris, FOIA/Privacy Act Specialist, Management. [FR Doc. 2016-27565 Filed 11-16-16; 8:45 am] BILLING CODE 6051-01-P3
![Federal Register / Vol. 81, No. 222 / Thursday, November 17, 2016 / Notices 81179
Time, Monday through Friday, Presiding Officer. A notice granting a (c) Estimated average bur- 75 minutes/30 min-
den per response. utes.
excluding government holidays. hearing will be published in the Federal (d) Estimated total reporting 875 hours/350
Participants who believe that they Register and served on the parties to the burden. hours.
have a good cause for not submitting hearing. (e) Estimated annual cost to Indeterminate.
documents electronically must file an For further details with respect to this respondents.
exemption request, in accordance with application, see the application dated
July 22, 2016. General Description of Collection:
10 CFR 2.302(g), with their initial paper
When an Applicant reports on the
filing stating why there is good cause for Dated at Rockville, Maryland, this 8th day Health History Form any history of
not filing electronically and requesting of November 2016.
asthma, he or she will be provided an
authorization to continue to submit For the Nuclear Regulatory Commission. Asthma Evaluation Form for the treating
documents in paper format. Such filings Balwant K. Singal, physician to complete The Asthma
must be submitted by: (1) First class Senior Project Manager, Plant Licensing Evaluation Form asks for the physician
mail addressed to the Office of the Branch IV–1, Division of Operating Reactor to document the Applicant’s condition
Secretary of the Commission, U.S. Licensing, Office of Nuclear Reactor of asthma, including any asthma
Nuclear Regulatory Commission, Regulation.
symptoms, triggers, treatments, or
Washington, DC 20555–0001, Attention: [FR Doc. 2016–27654 Filed 11–16–16; 8:45 am] limitations or restrictions due to the
Rulemaking and Adjudications Staff; or BILLING CODE 7590–01–P condition. This form will be used as the
(2) courier, express mail, or expedited
basis for an individualized
delivery service to the Office of the
determination as to whether the
Secretary, 11555 Rockville Pike, PEACE CORPS Applicant will, with reasonable
Rockville, Maryland, 20852, Attention:
accommodation, be able to perform the
Rulemaking and Adjudications Staff. Information Collection Request essential functions of a Peace Corps
Participants filing a document in this Submission for OMB Review Volunteer and complete a tour of service
manner are responsible for serving the
AGENCY:Peace Corps. without unreasonable disruption due to
document on all other participants.
60-day notice and request for
ACTION: health problems. This form will also be
Filing is considered complete by first-
comments. used to determine the type of
class mail as of the time of deposit in
accommodation that may be needed,
the mail, or by courier, express mail, or
SUMMARY: The Peace Corps will be such as placement of the Applicant
expedited delivery service upon
submitting the following information within reasonable proximity to a
depositing the document with the
collection request to the Office of hospital in case treatment is needed for
provider of the service. A presiding
Management and Budget (OMB) for a severe asthma attack.
officer, having granted an exemption
request from using E-Filing, may require review and approval. The purpose of
this notice is to allow 60 days for public • Diabetes Diagnosis Form
a participant or party to use E-Filing if
the presiding officer subsequently comment in the Federal Register (a) Estimated number of Ap- 55/55.
determines that the reason for granting preceding submission to OMB. We are plicants/physicians.
conducting this process in accordance (b) Frequency of response ... one time.
the exemption from use of E-Filing no (c) Estimated average bur- 75 minutes/30 min-
longer exists. with the Paperwork Reduction Act of den per response. utes.
1995 (44 U.S.C. Chapter 35). (d) Estimated total reporting 69 hours/28 hours.
Documents submitted in adjudicatory
proceedings will appear in the NRC’s DATES: Submit comments on or before burden.
January 17, 2017. (e) Estimated annual cost to Indeterminate.
electronic hearing docket which is respondents.
available to the public at http:// ADDRESSES: Comments should be
ehd1.nrc.gov/ehd/, unless excluded addressed to Denora Miller, FOIA/ General Description of Collection:
pursuant to an order of the Commission, Privacy Act Officer. Denora Miller can When an Applicant reports the
or the presiding officer. Participants are be contacted by telephone at 202–692– condition of diabetes Type 1 on the
requested not to include personal 1236 or email at pcfr@peacecorps.gov. Health History Form, the Applicant will
privacy information, such as social Email comments must be made in text be provided a Diabetes Diagnosis Form
security numbers, home addresses, or and not in attachments. for the treating physician to complete.
home phone numbers in their filings, FOR FURTHER INFORMATION CONTACT: In certain cases, the Applicant may also
unless an NRC regulation or other law Denora Miller at Peace Corps address be asked to have the treating physician
requires submission of such above. complete a Diabetes Diagnosis Form if
information. However, in some SUPPLEMENTARY INFORMATION:
the Applicant reports the condition of
instances, a petition will require Title: Individual Specific Medical diabetes Type 2 on the Health History
including information on local Evaluation Forms (15). Form. The Diabetes Diagnosis Form asks
residence in order to demonstrate a OMB Control Number: 0420–0550. the physician to document the diabetes
proximity assertion of interest in the Type of Request: Revision/New. diagnosis, etiology, possible
proceeding. With respect to copyrighted Affected Public: Individuals/ complications, and treatment. This form
works, except for limited excerpts that Physicians. will be used as the basis for an
serve the purpose of the adjudicatory Respondents Obligation to Reply: individualized determination as to
filings and would constitute a Fair Use whether the Applicant will, with
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Voluntary.
application, participants are requested Respondents: Potential and current reasonable accommodation, be able to
not to include copyrighted materials in volunteers. perform the essential functions of a
their submission. Burden to the Public: Peace Corps Volunteer assignment and
The Commission will issue a notice or complete a tour of service without
order granting or denying a hearing • Asthma Evaluation Form unreasonable disruption due to health
request or intervention petition, (a) Estimated number of Ap- 700/700.
problems. This form will also be used to
designating the issues for any hearing plicants/physicians. determine the type of accommodation
that will be held and designating the (b) Frequency of response ... one time. that may be needed, such as placement
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![81182 Federal Register / Vol. 81, No. 222 / Thursday, November 17, 2016 / Notices
including whether an insulin pump is agency’s estimate of the burden of the II. Self-Regulatory Organization’s
required, as well as the care and proposed collection of information, Statement of the Purpose of, and
maintenance of all required diabetes including the validity of the information Statutory Basis for, the Proposed Rule
related monitors and equipment. This to be collected; and, ways to minimize Change
form assists the Peace Corps in the burden of the collection of In its filing with the Commission, the
determining whether the Applicant will information on those who are to self-regulatory organization included
be in need of insulin storage while in respond, including through the use of statements concerning the purpose of,
service and, if so, will assist the Peace automated collection techniques, when and basis for, the proposed rule change
Corps in determining an appropriate appropriate, and other forms of and discussed any comments it received
placement for the Applicant. information technology. on the proposed rule change. The text
• Prescription for Eyeglasses Form This notice is issued in Washington, DC, of those statements may be examined at
on November 8, 2016. the places specified in Item IV below.
(a) Estimated number of Ap- 3,293/3,293.
Monique Harris, The Exchange has prepared summaries,
plicants/physicians.
set forth in sections A, B, and C below,
(b) Frequency of response ... one time. FOIA/Privacy Act Specialist, Management.
(c) Estimated average bur- 60 minutes/15 min- of the most significant parts of such
[FR Doc. 2016–27565 Filed 11–16–16; 8:45 am]
den per response. utes. statements.
(d) Estimated total reporting 3,293 hours/824 BILLING CODE 6051–01–P3
burden. hours. A. Self-Regulatory Organization’s
(e) Estimated annual cost to Indeterminate. Statement of the Purpose of, and
respondents. Statutory Basis for, the Proposed Rule
SECURITIES AND EXCHANGE Change
General Description of Collection: The
Prescription for Eyeglasses is used with COMMISSION 1. Purpose
Applicants who have reported on the The purpose of this filing is to amend
Health History Form that they use [Release No. 34–79291; File No. SR–
the Fee Schedule effective November 3,
corrective lenses or otherwise have NYSEArca–2016–144]
2016. Specifically, the Exchange
uncorrected vision that is worse than proposes to (i) modify the qualification
20/40. In these cases, Applicants are Self-Regulatory Organizations; NYSE
Arca, Inc.; Notice of Filing and for Tier 6 of Customer and Professional
provided a Prescription for Eyeglasses Customer Monthly Posting Credit Tiers
Form for their prescriber to indicate Immediate Effectiveness of Proposed
Rule Change To Amend the NYSE Arca and Qualifications in Penny Pilot Issues
eyeglasses frame measurements, lens (the ‘‘Posting Tiers’’); and (ii) modify
instructions, type of lens, gross vision Options Fee Schedule Effective
November 3, 2016 one aspect of the Customer and
and any special instructions. This form Professional Customer Incentive
is used in order to enable the Peace Program.
November 10, 2016.
Corps to obtain replacement eyeglasses
Currently, to qualify for Tier 6 of the
for a Volunteer during service. Pursuant to Section 19(b)(1) 1 of the
Posting Tiers, OTP Holders and OTP
Securities Exchange Act of 1934 (the
• Required Peace Corps Immunizations Form Firms (‘‘OTPs’’) must execute at least
‘‘Act’’) 2 and Rule 19b–4 thereunder,3
0.50% of Total Industry Customer
notice is hereby given that, on
(a) Estimated number of Ap- 5,600. equity and ETF option ADV (‘‘TCADV’’)
plicants/physicians. November 3, 2016, NYSE Arca, Inc. (the
from Customer and Professional
(b) Frequency of response ... one time. ‘‘Exchange’’ or ‘‘NYSE Arca’’) filed with Customer posted orders in all issues
(c) Estimated average bur- 60 minutes. the Securities and Exchange
den per response. (‘‘the options component’’), plus
(d) Estimated total reporting 5,600 hours. Commission (the ‘‘Commission’’) the executed ADV of 0.70% of U.S. equity
burden. proposed rule change as described in market share posted and executed on
(e) Estimated annual cost to Indeterminate. Items I, II, and III below, which Items
respondents. NYSE Arca Equity Market (‘‘the equity
have been prepared by the self- component’’). OTPs that achieve Tier 6
General Description of Collection: The regulatory organization. The are eligible to receive a $0.48 credit
Required Peace Corps Immunizations Commission is publishing this notice to applied to posted electronic Customer
Form is used to informed Applicants of solicit comments on the proposed rule and Professional Customer executions
the specific vaccines and/or change from interested persons. in Penny Pilot Issues.
documented proof of immunity required I. Self-Regulatory Organization’s In addition, the Customer and
for medical clearance for the specific Statement of the Terms of the Substance Professional Customer Incentive
country of service. The form advises the of the Proposed Rule Change Program (‘‘the Incentive Program’’),
Applicant that all other Center for which provides OTPs six alternatives to
Disease Control (CDC) recommended The Exchange proposes to amend the earn additional posting credits ranging
vaccinations will be administered after NYSE Arca Options Fee Schedule (‘‘Fee from $0.01 to $0.05, currently affords
arrival in-country. This form assists the Schedule’’). The Exchange proposes to OTPs the ability to earn an additional
Peace Corps with establishing a baseline implement the fee change effective $0.03 credit on Customer and
of the Applicants immunization history November 3, 2016. The proposed rule Professional Customer Posting Credits
and prepare for any additional vaccines change is available on the Exchange’s by meeting the same 0.70% minimum
asabaliauskas on DSK3SPTVN1PROD with NOTICES
recommended for country of service. Web site at www.nyse.com, at the qualification of the equity component as
Request for Comment: Peace Corps principal office of the Exchange, and at set forth in Tier 6.
invites comments on whether the the Commission’s Public Reference The Exchange is proposing to modify
proposed collections of information are Room. Tier 6 of the Posting Tiers by reducing
necessary for proper performance of the the options component from 0.50%
functions of the Peace Corps, including 1 15 U.S.C. 78s(b)(1). TCADV to 0.35% TCADV, while
whether the information will have 2 15 U.S.C. 78a. increasing the threshold of the equity
practical use; the accuracy of the 3 17 CFR 240.19b–4. component from 0.70% to 0.80% of U.S.
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Document Created: 2016-11-17 03:00:29
Document Modified: 2016-11-17 03:00:29
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | 60-day notice and request for comments. | |
| Dates | Submit comments on or before January 17, 2017. | |
| FR Citation | 81 FR 81179 |
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USC | CFR | eCFR