Information Collection Request

Submissions Related to the COVID-19 Vaccination Requirement

ICR 202111-3084-003 · OMB 3084-0170 · Historical Active

Forms and Documents

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

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 NewLetter for Final Job Offer
250489 Vaccination Certification Requirements for Prospective Employees with Federal Job Offers Form and Instruction New
250489 Vaccination Certification Requirements for Prospective Employees with Federal Job Offers Other-Emergency Request Letter New
250134 Medical Certification for COVID-19 Vaccine Exception for Federal Employees Form ModifiedPrivacy Act Statement for Medical Exception Form to COVID-19 Vaccination Requirement
250134 Medical Certification for COVID-19 Vaccine Exception for Federal Employees Form and Instruction ModifiedRequest for a Medical Exception to the COVID-19 Vaccination Requirement
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
  Inventory as of this Action Requested Previously Approved
07/31/2022 6 Months From Approved 05/31/2022
89 0 35
16 0 6
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Medical Certification for COVID-19 Vaccine Exception for Federal Employees Not Applicable, Unknown ,  
Medical Certification for COVID-19 Vaccine Exception for Prospective Employees with Job Offer
Vaccination Certification Requirements for Prospective Employees with Federal Job Offers Not Applicable

table that charts list of burden
  Total Approved 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