30-Day Notice of Proposed Information Collection: Employee Self-Certification and Ability To Perform in Emergencies (ESCAPE) Posts, Pre-Deployment Physical Exam Acknowledgement Form
The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Redu...
Notice of request for public comment and submission to OMB of proposed collection of information.
SUMMARY:
The Department of State has submitted the information collection described below to the Office of Management and Budget (OMB) for approval. In accordance with the Paperwork Reduction Act of 1995, we are requesting comments on this collection from all interested individuals and organizations. The purpose of this Notice is to allow 30 days for public comment.
DATES:
Submit comments up to September 10, 2026.
ADDRESSES:
Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to
www.reginfo.gov/public/do/PRAMain.
Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function.
FOR FURTHER INFORMATION CONTACT:
Direct requests for additional information regarding the collection listed in this notice, including requests for copies of the proposed collection instrument and supporting documents, to Director of Medical Clearances, Jessica Martinez, who may be reached on (202) 663-1657 or at
MartinezJA7@state.gov.
SUPPLEMENTARY INFORMATION:
Title of Information Collection:
Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) Posts, Pre-Deployment Physical Exam Acknowledgement Form.
OMB Control Number:
1405-0224.
Type of Request:
Revision of a Currently Approved Collection.
Originating Office:
Bureau of Medical Services, Office of Medical Clearances MED/CP/CS/CL.
Form Number:
DS-6570.
Respondents:
Contractors and eligible family members deploying to ESCAPE Diplomatic Missions requesting access to the Department of State Medical Program (currently Iraq, Juba, Kyiv, Libya, Peshawar, Somalia, Syria, and Yemen).
Estimated Number of Respondents:
3,800.
Estimated Number of Responses:
1,900.
Average Time per Response:
40 minutes (applicants); 30 minutes (physicians).
Total Estimated Burden Time:
2,216 hours.
Frequency:
Annually for those deployed to an ESCAPE post.
Obligation To Respond:
Required to Obtain or Retain a Benefit.
We are soliciting public comments to permit the Department to:
Evaluate whether the proposed information collection is necessary for the proper functions of the Department.
Evaluate the accuracy of our estimate of the time and cost burden for this proposed collection, including the validity of the methodology and assumptions used.
Enhance the quality, utility, and clarity of the information to be collected.
Minimize the reporting burden on those who are to respond, including the use of automated collection techniques or other forms of information technology.
Please note that comments submitted in response to this Notice are public record. Before including any detailed personal information, you should be aware that your comments as submitted, including your personal information, will be available for public review.
Abstract of Proposed Collection
The DS-6570 is completed by an individual and their medical provider to declare that the individual has health concerns that may represent a safety hazard for the individual or others at an ESCAPE Diplomatic Mission. ESCAPE is an acronym used to describe Diplomatic Missions overseas that are in extremely high threat, potentially combat, areas. Current ESCAPE Missions are Iraq, Juba, Kyiv, Libya, Peshawar, Somalia, Syria, and Yemen. This program is authorized under the Foreign Service Act of 1980, as implemented by the Department in 13 FAM 301.4-5.
Methodology
The respondents will be prompted access to the forms digitally based on their medical clearance needs (ESCAPE post designation). They will then take it to their personal medical provider for completion and authorization. Once complete, the forms will be submitted via a secure online platform for review by the Office of Medical Clearances.
Response to Public Comment
The Department published a notice in the
Federal Register
soliciting public comments for a period of 60 days. The Department received one comment. The commenter suggested that the burden
( printed page 51824)
calculation was inaccurate because it did not account for the burden on the non-federal healthcare providers who were filling out the DS-6570. The Department agrees and has provided revised burden estimates in paragraph 12. The other allegations from the commenter, including Privacy Act concerns, are without merit. The Department is in compliance with the Privacy Act, and the relevant System of Records Notice is up to date. Finally, the commenter cites E.O. 12866 in asking for a meeting with OIRA. We note that E.O. 12866 relates to rulemaking and does not provide any procedures under the Paperwork Reduction Act.
Jessica A. Martinez,
Director of Medical Clearances, Bureau of Medical Services, Department of State.
www.reginfo.gov/public/do/PRAMain