Supporting Statement -- NSF Medical and Religious Reasonable Accommodation Forms -- FINALv2 -- 2021-11-10

Supporting Statement
National Science Foundation (NSF)
COVID Medical and Religious Reasonable Accommodation Exception Forms
OMB# XXXX-XXXX Expiration date: XX/2021
Submitted November 10, 2021
Check off which applies:
New
Revision
Reinstatement with Change
Reinstatement without Change



Extension
Emergency
Existing w/o OMB approval

Federal Government Employee Information:
Suzanne Plimpton, Policy Analyst
National Science Foundation (NSF)
2415 Eisenhower Avenue
Alexandria, VA 22314
Telephone: 703-292-7556
Fax: 703-292-9242
Email: [email protected]

Table of Contents
A.

Justification

A.1

Circumstances Making the Collection of Information Necessary

A.2.

Purpose and Use of the Information Collection

A.3

Use of Information Technology and Burden Reduction

A.4

Efforts to Identify Duplication and Use of Similar Information

A.5

Impact on Small Businesses or Other Small Entities

A.6

Consequences of Collecting the Information Less Frequently

A.7

Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

A.8

Comments in Response to the Federal Register Notice and Efforts to Consult Outside Agency

A.9

Explanation of Any Payment of Gift to Respondents

A.10

Assurance of Confidentiality Provided to Respondents

A.11

Justification for Sensitive Questions

A.12

Estimates of Hour Burden Including Annualized Hourly Costs

A.13

Estimate of Other Total Annual Cost Burden to Respondents or Record keepers

A.14

Annualized Cost to the Federal Government

A.15

Explanation for Program Changes or Adjustments

A.16

Plans for Tabulation and Publication and Project Time Schedule

A.17

Reason(s) Display of OMB Expiration Date is Inappropriate

A.18

Exceptions to Certification for Paperwork Reduction Act Submissions

Attachments
1. Medical Exception Form
2. Religious Exception Form

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A. Justification
Pursuant to Executive Order 14043 (Sept. 9, 2021) and guidance issued by the Centers for Disease Control
and Prevention (CDC) and the Safer Federal Workforce Task Force (SFWTF), all Federal employees, as
defined by 5 U.S.C. 2105, must be vaccinated against COVID-19, with exceptions only as required by law, no
later than November 22, 2021. 1 This requirement extends to other NSF staff (e.g., Intergovernmental
Personnel Act (IPA) assignees, fellows, student volunteers), in accordance with applicable law, agreement,
and NSF policy. Consistent with Federal law, including title VII of the Civil Rights Act of 1964, the Americans
with Disabilities Act (ADA), the Rehabilitation Act of 1973, and Equal Employment Opportunity Commission
(EEOC) regulations, all such individuals must be afforded the right to request reasonable accommodation
from this vaccination requirement on medical or religious grounds. Accordingly, NSF requests emergency
clearance under the Paperwork Reduction Act (PRA), as provided in 5 CFR 1320.13 (emergency processing),
in order to conduct this collection of information in order to make expedited reasonable accommodation
determinations required under Federal law before the vaccination requirement goes into effect.
A.1

Circumstances Making the Collection of Information Necessary

See para. A above. The information collection is necessary to document and make determinations as to the
eligibility of individuals for reasonable accommodations or other legal exceptions from mandatory
vaccination requirements established by NSF for its employees and other staff under Executive Order
14043, CDC and SFWTF guidance, and other applicable law, agreement or NSF policy. As noted above, the
vaccination deadline is November 22, 2021.
Emergency clearance is being requested to allow sufficient time for individuals to request a reasonable
accommodation based on medical or religious grounds, and for NSF to make the required reasonable
accommodation or legal exception determinations. NSF, based on initial staff feedback, has provided
below a rough estimate of how many of its 1000+ staff may request such a determination. Each such
determination must be made on a case-by-case basis before the vaccination requirement is scheduled to
take effect on November 22, 2021. Prior to the expiration of the 180-day emergency approval period, NSF
intends to make a regular PRA clearance submission to allow this information collection activity to continue
for three years, because NSF will continue to need to collect the information at issue (e.g., from new
employees or other new NSF staff), until the COVID-19 public health emergency has abated, or the COVID19 vaccination requirement has been rescinded.
A.2 Purpose and Use of the Information Collection
See para. A.1 above. The NSF is conducting this information collection activity to afford individuals the right
and opportunity to seek a reasonable accommodation from above-described vaccination requirements on
medical or religious grounds. The information will be used by authorized NSF officials to make a case-bycase determination to grant or deny each such request. Where appropriate and necessary, this information
will be used in connection with agency efforts to maintain a safe and healthy workplace (i.e., to determine
what alternative workplace safeguards or procedures may need to followed if the employee remains
unvaccinated); for workforce flexibility and emergency planning purposes; to facilitate NSF cooperation
with public health authorities; in connection with contact tracing and exposure notification purposes; and
to comply with applicable legal recordkeeping and reporting requirements. The information (e.g.,
1

See https://www.saferfederalworkforce.gov/faq/vaccinations/

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individual’s vaccination or exempt status) may also be routinely used or disclosed, where authorized and
appropriate, to Federal, State, local or other agencies, health departments, medical authorities, or other
entities in connection with health screening, contact tracing, statistical reporting, and other efforts to
address the spread of communicable diseases and/or a public health emergency, as further described in
SORN NSF-78 (NSF Staff & Visitor Medical Information) and NSF-79 (NSF Health Program Records), which
have been submitted for emergency PRA clearance and approval. See also OPM/GOVT-10 (Employee
Medical Files System Records).
As noted above, to continue to respond to this national public health emergency, NSF will develop and
submit a separate full clearance package to OMB to continue using these reasonable accommodation forms
following the completion of the requested six-month emergency clearance.
A.3

Use of Information Technology and Burden Reduction

NSF information collection forms will be distributed primarily through electronic means (i.e., fillable PDFs).
Thus, individuals may complete the forms without printing or signing such forms in ink. Likewise, for the
medical reasonable accommodation form, part 2 of which must be completed by the individual’s medical
provider, the form may be transmitted to, completed, and returned by such provider to the individual by
electronic means. (To the extent, if any, that the completed form contains sensitive PII, the form may be
passworded or encrypted to prevent compromise.) The use of electronic means to distribute and collect
the information will minimize the burden on respondents.
A.4

Efforts to Identify Duplication and Use of Similar Information

The information collection activity is not duplicated by other information currently available to NSF. While
NSF has reasonable accommodation forms, the vaccination requirement is new and individual seeking such
an accommodation will have to provide specific information to explain why they cannot comply on medical
or religious grounds.
A.5

Impact on Small Businesses or Other Small Entities

Information will be collected primarily from NSF employees or other staff who are not small businesses or
other small entities for purposes of PRA clearance. The medical exception form (part 2) will collect
information from medical providers, some of whom may meet the definition of a small business or other
small entity. The impact on those entities, however, is estimated to be minimal. (See burden-hour
estimates below, paras. A.12 and A.14.)
A.6

Consequences of Collecting the Information Less Frequently

If this information collection is not conducted, or conducted less frequently, the consequences may include
the spread of the COVID-19 virus, serious illness, and fatalities in the NSF workplace or community, since
individuals may remain unvaccinated on medical or religious grounds without the agency’s knowledge or
authorization. The agency will also be in violation of Federal law if it fails to offer individuals the right and
opportunity to seek a reasonable accommodation (see paras. A. and A.1 above). By requiring individuals to
seek and be granted a reasonable accommodation, NSF will be able to identify such individuals and ensure
that they follow alternative safeguards or procedures to protect the health and safety of themselves and
others in the workplace and other NSF-sponsored in-person activities (e.g., meetings, review panels).
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A.7

Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

In response to the national public health emergency, NSF is requesting emergency clearance for this data
collection, including a request that OMB waive the normal requirement for the Federal Register
publication and public comment process before the NSF may sponsor or conduct the proposed
information collection activity. As explained above, all NSF staff must be vaccinated by November 22,
2021. Considering this deadline, emergency clearance is required so that NSF can properly identify and
process any reasonable accommodations requests as soon as possible in advance of that deadline, as
required by law. NSF intends to submit a regular request for OMB clearance in compliance with the full
requirements of 5 CFR 1320.5 to extend the emergency 180-day approval period that NSF is currently
requesting.
A.8.1

Comments in Response to the Federal Register Notice

Not applicable. As noted above, NSF is requesting that OMB waive the Federal Register publication
requirement and related public comment periods.
A.8.2

Efforts to Consult Outside Agency

Both information collection forms follow the templates prescribed by the Safer Federal Workforce Task
Force for reasonable accommodations based on a medical condition (10/4/2021) or religion (10/29/2021).
A.9

Explanation of Any Payment of Gift to Respondents

None, not applicable.
A.10

Assurance of Confidentiality Provided to Respondents

Personally identifiable information (PII) collected in this form will be stored electronically by secure means
as agency records within the NSF Privacy Act system for NSF staff and visitor medical information (SORN
NSF-78), which has already been submitted for emergency OMB review. The information may also be
stored as part of NSF’s Privacy Act system for its health program records (SORN NSF-79), which has also
been submitted for emergency OMB review with NSF-78, if the individual utilizes the services of the NSF
health program unit and reasonable accommodation information is also maintained in that unit’s records.
These systems are subject to the information security requirements of the Federal Information Security
Modernization Act of 2014 (FISMA) and other applicable Federal information security rules, standards, and
guidance.
The information shall not be disclosed without the subject individual’s written consent, except as
authorized by the Privacy Act of 1974, 5 U.S.C. 552a, including routine uses compatible with the purpose for
which the information is collected, as published in the SORNs that have also been submitted to OMB for
emergency review, as noted above.
A.11

Justification for Sensitive Questions

See paras. A., A.1, and A.2 above. The information collection activity is necessary to obtain the employee’s
justification for a medical or religious exception to the vaccination requirement discussed above as a
reasonable accommodation under applicable Federal law. Accordingly, it is necessary to ask the individual
questions regarding the specific basis for the request (e.g., medical or religious) and to provide appropriate
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supporting documentation, where appropriate (e.g., statement of the individual’s medical provider as to
the specific medical condition justifying the accommodation, or about the individual’s religious beliefs).
A.12.1 Estimates of Hour Burden Including Annualized Hourly Costs
Table 12-1
Estimated Annualized Burden Table
Average
Burden per
Response (in
hours)

Total Burden
Hours

(estimated)

No.
Responses
per
Respondent

NSF Request for a Medical
Exception to the COVID-19
Vaccination Requirement

100

1

3*

300

NSF request for a Religious
Exception to the COVID-19
Vaccination Requirement*

100

1

1**

100

Total

200

2

4

400

No. of
Respondents

Type of Collection

(estimated)

*This figure comprises one (1) hour for NSF employees, who are not members of the public for PRA clearance purposes, and other
NSF staff (e.g., IPA assignees, fellows) who complete this medical exception form (part 1), and two (2) hours for medical providers
who must also complete the form (part 2).
**This figure represents the estimated burden on primarily NSF employees (who are not who are members of the public for PRA
clearance purposes) and miscellaneous other NSF staff.

A.12-2 ANNUAL COST TO RESPONDENT
Provide estimates of annualized cost to respondents for the hour burdens for collections of information,
identifying and using appropriate wage rate categories. The cost of contracting out or paying outside
parties for information collection activities should not be included here.
Table 12-2 Annualized Cost to Respondents
Type of Respondents
Individuals (medical
providers)**
TOTAL

Total Annual
Burden Hours

Hourly Respondent
Wage Rate

Respondent Cost

200

$ 117.68*

$ 23,536

200

$ 117.68

$ 23,536

*Source: U.S. Dept. of Labor, Bureau of Labor Statistics, Occupation Wage and Employment Statistics (May 2020),
https://www.bls.gov/oes/current/oes_stru.htm. See Hourly Mean Wage for Offices of Physicians,
https://www.bls.gov/oes/current/oes291228.htm.
**Cost to NSF employees, who are not members of the public, is excluded from PRA clearance. Cost to non-employee NSF staff will
vary widely and cannot be reasonably estimated. The cost to them is expected to be relatively minimal, however, since the total
burden of these information collection forms will fall almost entirely on excluded NSF employees.

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A.13

Estimate of Other Total Annual Cost Burden to Respondents or Record Keepers

Not applicable. The forms will be collected and maintained by NSF. Respondents (e.g., medical providers)
are not required to retain a copy of the information collection forms, although they may do so voluntarily.
A.14

Annualized Cost to the Federal Government

Cost Descriptions
Federal Oversight
Branch Chief
Admin. Specialist

Contractor Cost
Medical Director
Other Cost

Grade/Step
GS-15/10
GS-11/5

Salary*

% of
Effort

$172,500
$82,453

N/A

$208.14/hour

Fringe (if
applicable)
10 **
5 **

10 N/A

Total

Total Cost to Gov’t
$17,250
$4123

$41,628***

$63,001

*Source: For Federal Oversight, U.S. Office of Personnel Mgt. (OPM), Pay & Leave, Salaries & Wages, Salary Table 2021-DCB (eff.

Jan. 2021), https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/21Tables/html/DCB.aspx.
**Fringe benefits may result in an additional 30-40% in annual cost, based on comparable FY2021 civilian defense personnel data.
See https://comptroller.defense.gov/Portals/45/documents/rates/fy2021/2021_d.pdf.
***Annual cost estimate based on contractor performing services 40 hours/week and 50 weeks/year.

A.15

Explanation for Program Changes or Adjustments

This request is for a new information collection activity (see para. A.4 above).
A.16

Plans for Tabulation and Publication and Project Time Schedule

Activity

A.16 - 1 Project Time Schedule
Time Schedule

Forms Disseminated to Respondents

1 week - 6 months after OMB approval

Analyze and Make Determinations Based
on Responses (No Public Reporting)

1 week – 6 months after OMB approval

A.17

Reason(s) Display of OMB Expiration Date is Inappropriate

Not applicable. Once the information collection activity is approved, an OMB control number will be
displayed (including the expiration date) for each information collection form.
A.18

Exceptions to Certification for Paperwork Reduction Act Submissions

None.
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