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

Documents and forms in this information collection
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
Form AID 111-9 U.S. Personal Services Contractor Request for a Medical Exception To The Covid-19 Vaccination Requirement 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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AID 111-9				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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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