Information Collection

U.S. Personal Services Contractor Request for a Medical Exception To The Covid-19 Vaccination Requirement

IC 250242 under ICR 202111-0412-001 · OMB 0412-0613.

Documents and Forms

Document Name Document Type
Form AID 111-9 U.S. Personal Services Contractor Request for a Medical Exception To The Covid-19 Vaccination Requirement Form
AID 111-9 U.S. Personal Services Contractor Request for a Medical USPSC REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT -- a111-9.pdf Form
AID 111-9 U.S. Personal Services Contractor Request for a Medical USPSC REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT -- a111-9.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	U.S. Personal Services Contractor Request for a Medical Exception To The Covid-19 Vaccination Requirement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AID 111-9	U.S. Personal Services Contractor Request for a Medical Exception To The Covid-19 Vaccination Requirement	USPSC REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT -- a111-9.pdf		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records
Title: Personal Services Contracts Records	FR Citation: 80 FR 11391

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.