Request for a Medical
Exception to the COVID-19 Vaccination Requirement
Extension without change of a currently approved collection
No
Regular
03/22/2022
Requested
Previously Approved
36 Months From Approved
05/31/2022
20
20
20
20
1,012
1,012
To comply with the September 9, 2021,
Executive Order (E.O.) 14043 (Requiring Coronavirus Disease 2019
Vaccination for Federal Employees) and October 2021 guidance from
the Safer Federal Workforce Task Force, the NTSB created the
following form: Request for a Medical Exception to the COVID-19
Vaccination Requirement. The agency will use this form to determine
whether the employee provided sufficient information to justify the
request. Because the OMB number assigned to this form was obtained
through emergency clearance, the OMB number is only valid for six
months and will expire on May 31, 2022. In anticipation of future
requests from its employees, the NTSB is specifically seeking an
extension of this currently-approved collection.
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:
(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;
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.