Justification for Vaccine Medical Exemption (emergency clearance)

U. S. OFFICE OF GOVERNMENT ETHICS
SUPPORTING STATEMENT FOR
OGE REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19
VACCINATION REQUIREMENT
NOVEMBER 2021
A. Justification
1.-2. Explain the circumstances that make the collection of information necessary.
Indicate how, by whom, and for what purpose the information is to be used. Except
for a new collection, indicate the actual use the agency has made of the information
received from the current collection.
This information is essential to implement OGE’s health and safety measures
included in recent Centers for Disease Control and Prevention and Safer Federal
Workforce Task Force Guidance. OGE is using the template provided by the Safer
Federal Workforce Task Force. The information is necessary to document the
consideration, decision, and implementation of requests for reasonable accommodation
from the COVID vaccination requirement set forth in Executive Order 14043, Requiring
Coronavirus Disease 2019 Vaccination for Federal Employees (Sept. 9, 2021).
3. Describe whether, and to what extent, the collection of information involves the
use of automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology.
The information collection, like the template it is based on, is a fillable pdf.
4. Describe efforts to identify duplication. Show specifically why any similar
information already available cannot be used or modified for use for the purposes
described in item 2 above.
OGE is using the template recommended by the Safer Federal Workforce Task
Force, which requires that a medical providers answer specific questions about the
employee’s request for a medical accommodation. OGE does not currently collect that
information from medical providers, nor is there any other source of such information.
5. If the collection of information impacts small businesses or other small entities,
describe any methods used to minimize burden.
Not applicable. This collection of information does not involve small businesses
or other small entities.
6. Describe the consequence to Federal program or policy activities if the collection
is not conducted or is conducted less frequently, as well as any technical or legal
obstacles to reducing the burden.

If the information is not collected, OGE will not be able to process requests for
medical exceptions to the vaccination requirement. As a result, OGE may not be able to
comply with Executive Order 14043 and/or the Rehabilitation Act of 1973.
7. Explain any special circumstances that would cause an information collection to
be conducted in a manner:
• Requiring respondents to report information to the agency more often than
quarterly;
• Requiring respondents to prepare a written response to a collection of
information in fewer than 30 days after receipt of it;
• Requiring respondents to submit more than an original and two copies of
any document;
• Requiring respondents to retain records, other than health, medical,
government contract, grant-in-aid, or tax records, for more than 3 years;
• In connection with a statistical survey, that is not designed to produce valid
and reliable results that can be generalized to the universe of study;
• Requiring the use of a statistical data classification that has not been
reviewed and approved by OMB;
• That includes a pledge of confidentiality that is not supported by authority
established in statute or regulation, that is not supported by disclosure and
data security policies that are consistent with the pledge, or that
unnecessarily impedes sharing of data with other agencies for compatible
confidential use; or
• Requiring respondents to submit proprietary trade secrets or other
confidential information unless the agency can demonstrate that it has
instituted procedures to protect the information's confidentiality to the
extent permitted by law.
No such special circumstances exist.
8. If applicable, provide a copy and identify the date and page number of
publication in the Federal Register of the agency's notice, required by 5 CFR
1320.8(d), soliciting comments on the information collection prior to submission to
OMB.
Because this information collection concerns an urgent safety need, OGE requests
OMB’s approval to waive the need for the Federal Register Notices otherwise required
prior to publication.
9. Explain any decision to provide any payment or gift to respondents, other than
remuneration of contractors or grantees.
Not applicable. Respondents receive no payments or gifts.

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10. Describe any assurance of confidentiality provided to respondents and the basis
for the assurance in statute, regulation, or agency policy.
There is no assurance of confidentiality, however the information is protected by
the Privacy Act.
11. Provide additional justification for any questions of a sensitive nature, such as
sexual behavior and attitudes, religious beliefs, and other matters that are
commonly considered private.
Although the information is medical information, which is commonly considered
private, it is necessary to review and make a determination on requests for medical
accommodations. Only the minimum necessary information is sought.
12. Provide estimates of the hour burden of the collection of information.
OGE estimates that fewer than five OGE employees annually will seek a medical
accommodation to the vaccine mandate. Although it is unclear whether employees will
be asked to resubmit the request after a certain length of time, we estimate that no single
respondent will submit the information more than once per decade.
The information sought from medical providers is minimal and will be based on
the provider’s preexisting records. OGE estimates that it should take no more than ten
minutes for the medical provider to complete their portion of the form.
Accordingly, the total annual time burden is estimated to be 0.17 hours.
13. Provide an estimate for the total annual cost burden to respondents or recordkeepers resulting from the collection of information.
Based on the above, the total annual cost burden for private citizen filers is
estimated to be $17. This is based on information from the Bureau of Labor Statistics,
which indicates that the 2020 median pay of physicians and surgeons is $100 per hour.
14. Provide an estimate of annualized costs to the Federal Government.
There should be no additional cost to the Federal Government. Collecting and
reviewing this information is just a very small fraction of the work performed by salaried
employees.
15. Explain the reasons for any program changes or adjustments reported in items
12 through 14.
Not applicable.

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16. For collections of information whose results will be published, outline plans for
tabulation and publication.
Not applicable.
17. If seeking approval to not display the expiration date for OMB approval of the
information collection, explain the reasons that display would be inappropriate.
Not applicable.
18. Explain each exception to the topics of the certification statement identified in
Certification for Paperwork Reduction Act Submissions.
Certification items (c), (f) and (i) are not applicable to this information collection.
B. Collections of Information Employing Statistical Methods
Not applicable. This collection of information does not employ statistical
methods.

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