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NASA COVID-19 Vaccine Exception NASA Form (NF) 1699C Request for Medical Exception

IC 249211 under ICR 202109-2700-001 · OMB 2700-0186.

Documents and Forms
Document Name
Document Type
Other-Attestation Form
Other-Attestation Form
Other-screenshots of form
Form and Instruction
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NASA COVID-19 Vaccine Exception NASA Form (NF) 1699C Request for Medical Exception
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NF-1699C REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Request for Medical Exception.NF1699C.pdf https://nef.nasa.gov/forms/1602093956 Yes Yes Fillable Fileable
Other-screenshots of form NF1699C Medical Exemption screenshots.docx https://nef.nasa.gov/forms/1602093956 Yes Yes Fillable Fileable

General Science and Innovation Scientific and Technological Research and Innovation

NASA 10RAR Reasonable Accommodations Records  86 FR 63073

1,200 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 170 0 170 0 0 0
Annual IC Cost Burden (Dollars) 15,600 0 15,600 0 0 0

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