Information Collection

Request for a Medical Exception to the COVID-19 Vaccination

IC 250439 under ICR 202203-2501-004 · OMB 2501-0037.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HUD-1001 Request for a Medical Exception to the COVID-19 Vaccination	Form and Instruction
HUD-1001 Request for a Medical Exception to the COVID-19 Vaccinat DISABILITY EXCEPTION REQUEST FORM Nov 2021.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	HUD-1001	Request for a Medical Exception to the COVID-19 Vaccination Requirement	DISABILITY EXCEPTION REQUEST FORM Nov 2021.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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