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

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

OMB: 3147-0028

IC ID: 250005

Information Collection (IC) Details

View Information Collection (IC)

Request for a Medical Exception to the COVID-19 Vaccination Requirement
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Request for a Medical Exception to the COVID-19 Vaccination Requirement NTSB FORM Request for Medical Exception.pdf Yes Yes Fillable Fileable

Transportation Air Transportation

NTSB 28 Employee Medical Folders  77 FR 62060

20 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   85 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 20 0 0 0 0 20
Annual IC Time Burden (Hours) 20 0 0 0 0 20
Annual IC Cost Burden (Dollars) 1,012 0 0 0 0 1,012

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