Information Collection

Medical Exception Request to the Vaccination Requirement

IC 250454 under ICR 202111-3079-001 · OMB 3079-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3079-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FMSHRC-09-001 Medical Exception Request to the Vaccination Requirement	Form and Instruction
FMSHRC-09-001 Medical Exception Request to the Vaccination Requirement FMSHRC Religious Exception Request Form_V2_11-03-2021.pdf	Form and Instruction

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

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		Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.