Medical Exemption Delay to Covid-19 Requirement

ICR 202111-2501-001

OMB: 2501-0037

Federal Form Document

IC Document Collections
ICR Details
202111-2501-001
Received in OIRA
HUD/HUDSEC
Medical Exemption Delay to Covid-19 Requirement
New collection (Request for a new OMB Control Number)   No
Emergency 11/22/2021
11/19/2021
  Requested Previously Approved
6 Months From Approved
200 0
300 0
0 0

Consistent with Executive Order 14043 on September 9, 2021, requiring federal employees to be vaccinated against COVID-19 in order to ensure the health and safety of federal workers and efficiency of the civil service. Requests for an exception to the COVID vaccination requirement will be documented on Form HUD-1001 Request to Medical Exception to the COVID-19 Requirement.
Executive Order 14043 on September 9, 2021, requiring federal employees to be vaccinated against COVID-19 in order to ensure the health and safety of federal workers and efficiency of the civil service. Requests for an exception to the COVID vaccination requirement will be documented on Form HUD-1001 Request to Medical Exception to the COVID-19 Requirement.

None
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Request for a Medical Exception to the COVID-19 Vaccination HUD-1001 Request for a Medical Exception to the COVID-19 Vaccination Requirement

  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 200 0 0 200 0 0
Annual Time Burden (Hours) 300 0 0 300 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
new collection

$14,904
No
    Yes
    Yes
No
No
No
Yes
Erica Jones 202 402-6032

  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.
11/19/2021


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