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

Forms and Documents

Document Name	Status
Physicians Form	Unchanged
Job Applicants Form	Unchanged
1557-0352 Vaccine Medical Exception Supporting Statement 3-23-22.docx Supporting Statement A	2022-03-24

IC Document Collections

IC ID	Document Title	Status
249960	Physicians Form	Unchanged
249959	Job Applicants Form	Unchanged

ICR Details

OMB Control No: 1557-0352	ICR Reference No: 202203-1557-005
Status: Received in OIRA	Previous ICR Reference No: 202110-1557-003
Agency/Subagency: TREAS/OCC	Agency Tracking No:
Title: Request for a Medical Exception to the COVID-19 Vaccine Requirement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/29/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2022
Responses	68	68
Time Burden (Hours)	34	34
Cost Burden (Dollars)	0	0

---

Abstract: The President, by Executive order 13991 (January 20, 2021) established the Safer Federal Workforce Task Force. The Taskforce was established to give the heads of federal agencies ongoing guidance to keep their employees safe and their agencies operating during the COVID-19 pandemic. The Taskforce issued guidance, in accordance with the President’s Executive Order 14043 (September 9, 2021), requiring federal employees to be vaccinated against COVID-19 by November 22, 2021 absent a legally required exception. To determine whether employees who request a medical exception qualify for the exception and a reasonable accommodation, or, alternatively, was required to comply with the November 22 deadline, the OCC developed the Request for Medical Exception to the COVID-19 Vaccination Requirement form (Request form). The Request form was developed, consistent with guidance issued by the Taskforce and the U.S. Department of Treasury’s Office of Civil Rights and Diversity, to gather information from employees who have requested medical exceptions and medical professionals treating those employees, to determine whether such employees qualify for legal exceptions to the vaccine requirement. The Request form was used to collect information from job applicants who may request a legal exception and reasonable accommodation after receiving an offer of employment from the OCC. To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, Office of the Comptroller of the Currency will take no action to implement or enforce the COVID-19 vaccination requirement pursuant to Executive Order 14043 on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees while the injunction is in effect.

---

Authorizing Statute(s): US Code: 12 USC 1 et seq. Name of Law: The National Bank Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 2669	01/18/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18068	03/29/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Job Applicants	N/A	Medical Exception to COVID Vaccination Requirement
Physicians	N/A	Medical Exception to COVID Vaccination Requirement

---

ICR Summary of Burden

	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	68	68	0	0	0	0
Annual Time Burden (Hours)	34	34	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/29/2022

---