Requiring Coronavirus Disease 2019 Vaccination for Federal Employees

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3240-0040 can be found here:

Documents and Forms

Document Name Document Type
Emergency letter ICR.pdf Emergency Letter to OMB OIRA IC Document
Emergency letter ICR.pdf Emergency Letter to OMB OIRA IC Document

Information Collection (IC) Details

IC Title:	Requiring Coronavirus Disease 2019 Vaccination for Federal Employees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 5 CFR 1320.13

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Reasonable Accommodation, Religious Exception, and Medical Exception Health Records	FR Citation: 87 FR 2199

Number of Respondents: 8	Number of Respondents for Small Entity: 8

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8	8
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Emergency Letter to OMB OIRA	Emergency letter ICR.pdf	01/12/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.