EPA Medical Certification for Covid-19 Vaccination Exception Request.

ICR 202111-2030-002

OMB: 2030-0053

Federal Form Document

IC Document Collections
ICR Details
202111-2030-002
Received in OIRA
EPA/OMS 2704.01
EPA Medical Certification for Covid-19 Vaccination Exception Request.
New collection (Request for a new OMB Control Number)   No
Emergency 11/24/2021
11/23/2021
  Requested Previously Approved
6 Months From Approved
175 0
175 0
0 0

Executive Order 14043, Requiring Coronavirus Disease 2019 Vaccination for Federal Employees (September 9, 2021), requires all Federal Employees as defined in 5 U.S.C. 2105, to be vaccinated against COVID-19, with exceptions only as required by law. In order to make determinations on requests for medical exceptions to the vaccine mandate, EPA needs to collect information, including medical certification from the employee’s medical provider to support their request for accommodation. This information is essential to implement health and safety measures requiring all Federal employees be vaccinated against COVID-19.
Pursuant to section 3507(j) of the Paperwork Reduction Act (PRA) (44 U.S.C. 3501 et seq.), as implemented in the Office of Management and Budget (OMB) regulations at 5 CFR §1320.13, the Environmental Protection Agency (EPA) is hereby requesting emergency processing of an information collection necessary for collecting information from individuals applying for medical exemption to the COVID-19 Mandatory Vaccinations. Given the critical role of the collection of information to meeting our commitments as outlined in Executive Order (E.O.) 14043 of September 9, 2021, Requiring Coronavirus Disease 2019 Vaccination for Federal Employees and the Safer Federal Workforce Task Force guidance, EPA cannot reasonably comply with the normal clearance procedures.

None
None

Not associated with rulemaking

No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 175 0 0 175 0 0
Annual Time Burden (Hours) 175 0 0 175 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.

$30,870
No
    Yes
    Yes
No
No
No
No
Courtney Kerwin 202-566-1669

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/23/2021


© 2021 OMB.report | Privacy Policy