State Dept Wants Comments on Emergency Selfie Certification Form
Published Date: 8/11/2026
Notice
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.
Analyzed Economic Effects
3 provisions identified: 0 benefits, 3 costs, 0 mixed.
DS-6570 Required for ESCAPE Contractors
If you are a contractor deploying to an ESCAPE diplomatic post (Iraq, Juba, Kyiv, Libya, Peshawar, Somalia, Syria, or Yemen), you must complete the DS-6570 pre-deployment form annually to request access to the Department of State Medical Program. The agency estimates 3,800 respondents, 1,900 responses, and an average applicant time of 40 minutes per response (total estimated burden 2,216 hours).
DS-6570 Required for Eligible Family Members
Eligible family members deploying to ESCAPE diplomatic posts (Iraq, Juba, Kyiv, Libya, Peshawar, Somalia, Syria, or Yemen) must complete the DS-6570 pre-deployment physical exam acknowledgement form annually to request access to the Department of State Medical Program. The Department estimates overall respondent counts and burden (3,800 respondents; total estimated burden 2,216 hours) that include family-member respondents.
Physician Time to Complete DS-6570
Non-federal medical providers who complete the DS-6570 for applicants are estimated to spend about 30 minutes per response. The Department revised burden estimates to account for non-federal health care providers and reports an average physician time of 30 minutes per completed form.
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Key Dates
Related Federal Register Documents
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