Federal Government

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

OMB: 3060-1295

IC ID: 249997

Information Collection (IC) Details

View Information Collection (IC)

Federal Government OWD
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction FCC Form 5643 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT MEDICAL EXCEPTION FORM - Vaccination FCC 12 7 21 v7 FINAL.pdf Yes Yes Fillable Fileable

General Government Central Fiscal Operations

FCC/OWD-1, Reasonable Accommodation Requests   84 FR 3163

34 0
   
Federal Government
 
   100 %

  Approved 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
Annual Number of Responses for this IC 34 0 0 0 0 34
Annual IC Time Burden (Hours) 17 0 0 0 0 17
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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