Medical Exception Request to the COVID-19 Vaccination Requirement

ICR 202111-3079-001

OMB:

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supplementary Document
2021-11-22
Supporting Statement A
2021-11-22
IC Document Collections
ICR Details
202111-3079-001
Received in OIRA
FMSHRC
Medical Exception Request to the COVID-19 Vaccination Requirement
New collection (Request for a new OMB Control Number)   No
Emergency 12/03/2021
11/22/2021
  Requested Previously Approved
6 Months From Approved
6 0
24 0
0 0

In order to ensure the health and safety of the Federal workforce and the efficiency of the civil service, full Coronavirus Disease 2019 Vaccination is now mandatory for all Federal employees, with exceptions only required by law, under the new Executive Order 14043. Employees may seek a legal exception to the vaccination requirement due to a disability or medical reason. Requests for “medical accommodation” or “medical exceptions” will be treated as requests for disability accommodation and evaluated and decided under applicable Rehabilitation Act standards for reasonable accommodation absent undue hardship to the agency. An employee may also request a delay for complying with the vaccination requirement based on certain medical considerations that may not justify an exception under the Rehabilitation Act. Safer Federal Workforce Task Force guidance on medical considerations that may warrant a delay is available here.
In accordance with government-wide policy that 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. Our agency is currently conducting the requisite steps so our employees may seek a legal exception to the vaccination requirement due to a disability. Requests for “medical accommodation” or “medical exceptions” will be treated as requests for disability accommodation and evaluated and decided under applicable Rehabilitation Act standards for reasonable accommodation absent undue hardship to the agency. Before we are able to circulate request forms to requestors, the Safer Federal Workforce Task Force has directed us to seek emergency review from OIRA.

US Code: 29 USC 791 Name of Law: Rehabilitation Act Section 501
   EO: EO 14043 Name/Subject of EO: Requiring Coronavirus Disease 2019 Vaccination for Federal Employees
  
EO: EO 14043 Name/Subject of EO: Requiring Coronavirus Disease 2019 Vaccination for Federal Employees

Not associated with rulemaking

86 FR 66301 11/22/2021
No

1
IC Title Form No. Form Name
Medical Exception Request to the Vaccination Requirement FMSHRC-09-001 Medical Exception Request to the 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 6 0 0 6 0 0
Annual Time Burden (Hours) 24 0 0 24 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
The increase in burden occurred due to a new federal mandate requiring all federal employees to be vaccinated for COVID-19. There is a minimal increase in burden for federal employees that will utilize the form to request a reasonable accommodation to the COVID-19 vaccination. We have been informed that 5-6 employees intend to request a medical exception. There is minimal increase in burden to the one staff member who will be processing, documenting and storing those requests. The largest burden was on the staff who had to interpret the new federal mandate, create the collection form, draft a Reasonable Accommodation SORN, and comply with the Privacy Act and Paperwork Reduction Act.

$999
No
    Yes
    Yes
No
No
No
Yes
Michael Chirico 202 434-9909 [email protected]

  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.
11/22/2021


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