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Usdh Request For A Medical Exception To The Covid-19 Vaccination Requirement

IC 249937 under ICR 202110-0412-003 · OMB 0412-0612.

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Form
Form
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USDH REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form AID 111-8 USDH REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT USDH REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT (editable)_FINAL.pdf Yes Yes Fillable Fileable

International Affairs and Commerce International Development and Humanitarian Aid

Reasonable Accommodations Records  81 FR 70085

40 0
   
Private Sector Businesses or other for-profits
 
   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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 30 0 30 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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