Information Collection

Requiring Coronavirus Disease 2019 Vaccination for Federal Employees

IC 251114 under ICR 202201-3240-001 · OMB 3240-0040.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.