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

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

OMB: 3124-0016

IC ID: 251045

Information Collection (IC) Details

View Information Collection (IC)

Request for Medical and Religious Exception to the COVID-19 Vaccination Requirement
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Request for a Medical Exception to the COVID-19 Vaccination Requirement Request for a Medical Exception to the COVID-19 Vaccination Requirement (Final).pdf Yes Yes Fillable Fileable Signable
Form and Instruction n/a Request for a Religious Exception to the COVID-19 Vaccination Requirement Request for a Religious Exception to the COVID-19 Vaccination Requirement.pdf Yes Yes Fillable Fileable Signable

Health Immunization Management

MSPB-3, Reasonable Accommodations  86 FR 73001

70 0
   
Individuals or Households
 
   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 70 0 70 0 0 0
Annual IC Time Burden (Hours) 70 0 70 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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