Information Collection Request

Submissions Related to the COVID-19 Vaccination Requirement

ICR 202111-3084-003 · OMB 3084-0170 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Not Applicable Vaccination Certification Requirements for Prospective Employees with Federal Job Offers Form and Instruction New Repair queued
Form Unknown Medical Certification for COVID-19 Vaccine Exception for Federal Employees Form and Instruction Modified Missing upstream
Medical Exception Request-letter-11_8_21.pdf Supplementary Document Uploaded 2021-11-10 Missing upstream
Medical Exception Request-Letter-11_4_21.pdf Supplementary Document Uploaded 2021-11-05 Missing upstream
Supplemental Supporting Statement for New Employee Hires-11-30-2021-FINAL.pdf Supporting Statement A Uploaded 2021-11-30 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
250593 Medical Certification for COVID-19 Vaccine Exception for Prospective Employees with Job Offer Other-Emergency Justification Letter New
250489 Vaccination Certification Requirements for Prospective Employees with Federal Job Offers Form and Instruction New
250134 Medical Certification for COVID-19 Vaccine Exception for Federal Employees Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
6 Months From Approved 05/31/2022
89 35
16 6
0 0





table that charts list of burden
  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 89 35 54 0 0 0
Annual Time Burden (Hours) 16 6 0 10 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No