Information Collection Request

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

ICR 202203-1557-005 · OMB 1557-0352 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Physicians Form Unchanged Repair queued
Job Applicants Form Unchanged Repair queued
1557-0352 Vaccine Medical Exception Supporting Statement 3-23-22.docx Supporting Statement A Uploaded 2022-03-24 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
249960 Physicians Form Unchanged
249959 Job Applicants Form Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 05/31/2022
68 68
34 34
0 0





Reginfo record details
2
table that charts list of burden
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

table that charts list 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


Reginfo record details
  No