Request for Medical and Religious Exception to the COVID-19 Vaccination Requirement

ICR 202201-3124-001

OMB: 3124-0016

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supplementary Document
2022-01-06
Supplementary Document
2022-01-06
Supporting Statement A
2022-01-06
ICR Details
202201-3124-001
Received in OIRA
MSPB
Request for Medical and Religious Exception to the COVID-19 Vaccination Requirement
New collection (Request for a new OMB Control Number)   No
Emergency 01/10/2022
01/06/2022
  Requested Previously Approved
6 Months From Approved
70 0
70 0
0 0

This Information Collection Request (ICR) seeks an emergency Paperwork Reduction Act (PRA) clearance to allow the U.S. Merit Systems Protection Board (MSPB) to collect information from individuals applying for an exception to the mandatory COVID-19 vaccination under Executive Order 14043, “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees” (Sept. 9, 2021). MSPB is unable to comply with the normal PRA clearance procedures given the critical role of the collection of information to meeting our commitments under Executive Order 14043.
This information is essential to implement health and safety measures mandated by Executive Order 14043, “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees” (Sept. 9, 2021) and included within recent Safer Federal Workforce Task Force Guidance. Government agencies have an urgent need to request medical and religious exception information from federal employees with input from medical professionals and religious or spiritual advisors. Applying regular Paperwork Reduction Act clearance procedures is likely to cause harm because of the threat of COVID-19 exposure and transmission (5 C.F.R. § 1320.13(a)(2)(i)).

EO: EO 14043 Name/Subject of EO: “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees” (Sept. 9, 2021)
  
None

Not associated with rulemaking

No

  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 70 0 0 70 0 0
Annual Time Burden (Hours) 70 0 0 70 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.

$41,659
No
    Yes
    Yes
No
No
No
Yes
Fon Muttamara 202 254-4772 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/06/2022


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