Requiring Coronavirus Disease 2019 Vaccination for Federal Employees

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

Documents and Forms

Document Name Document Type
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: Unchanged

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 %

	Requested	Previously Approved
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.