Request for a Medical Exception to the COVID-19 Vaccination

Medical Exemption Delay to Covid-19 Requirement

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2501-0037 can be found here:

Documents and Forms

Document Name Document Type
Form HUD-1001 Request for a Medical Exception to the COVID-19 Vaccination Form and Instruction
HUD-1001 Request for a Medical Exception to the COVID-19 Vaccinat DISABILITY EXCEPTION REQUEST FORM Nov 2021.pdf Form and Instruction
HUD-1001 Request for a Medical Exception to the COVID-19 Vaccinat DISABILITY EXCEPTION REQUEST FORM Nov 2021.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Request for a Medical Exception to the COVID-19 Vaccination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HUD-1001	Request for a Medical Exception to the COVID-19 Vaccination Requirement	DISABILITY EXCEPTION REQUEST FORM Nov 2021.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	300	300
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.