NRC Form 798, “Request for a Medical Exception to the COVID-19 Vaccine Requirement"

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NRC Form 798 NRC Form 798, Request for a Medical Exception to the COVID-19 Vaccination Requirement	Form and Instruction	Modified	Repair queued
Final Supporting statement NRC Form 798.docx	Supporting Statement A	Uploaded 2022-03-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249896	NRC Form 798, Request for a Medical Exception to the COVID-19 Vaccination Requirement	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0249	ICR Reference No: 202203-3150-004
Status: Received in OIRA	Previous ICR Reference No: 202110-3150-001
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 798, “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: 03/28/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2022
Responses	10	50
Time Burden (Hours)	5	25
Cost Burden (Dollars)	0	0

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Abstract: Executive Order (E.O.) 14043, titled, “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees,” requires all Federal employees, as defined in 5 U.S.C. § 2105, to be vaccinated against COVID-19, with exceptions only as required by law. Requests for "medical accommodation" or "medical exceptions" will be treated as requests for a disability accommodation and evaluated and decided under applicable Rehabilitation Act standards for reasonable accommodation absent undue hardship to the agency. An employee may also request a delay for complying with the vaccination requirement based on certain medical considerations that may not justify an exception under the Rehabilitation Act. The agency will be required to keep confidential any medical information provided, subject to the applicable Rehabilitation Act standards. Employees who receive an exception or a delay from the vaccination requirement would instead comply with alternative health and safety protocols. NRC Form 798, “Request for a Medical Exception to the COVID-19 Vaccine Requirement” will be completed by employees who seek a medical exception and by their personal medical providers. The vaccination requirement issued pursuant to E.O. 14043, is currently the subject of a nationwide injunction. While that injunction remains in place, the NRC will not process requests for a medical exception from the COVID-19 vaccination requirement pursuant to E.O. 14043. The NRC will also not request the submission of any medical information related to a request for an exception from the vaccination requirement pursuant to E.O. 14043 while the injunction remains in place, but the NRC may nevertheless receive information regarding a medical exception. That is because, if the NRC were to receive a request for an exception from the COVID-19 vaccination requirement pursuant to E.O. 14043 during the pendency of the injunction, the NRC will accept the request, hold it in abeyance, and notify the employee who submitted the request that implementation and enforcement of the COVID-19 vaccination requirement pursuant to E.O. 14043 is currently enjoined and that an exception therefore is not necessary so long as the injunction is in place. In other words, during the pendency of the injunction, any information collection related to requests for medical exception from the COVID-19 vaccination requirement pursuant to E.O. 14043 is not undertaken to implement or enforce the COVID-19 vaccination requirement.

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Authorizing Statute(s): EO: EO 14043 Name/Subject of EO: Requiring Coronavirus Disease 2019 Vaccination for Federal Employees
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 73808	12/28/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 17344	03/28/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
NRC Form 798, Request for a Medical Exception to the COVID-19 Vaccination Requirement	NRC Form 798	Request for a Medical Exception to the COVID-19 Vaccine Requirement

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ICR Summary of Burden

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	10	50	0	0	-40	0
Annual Time Burden (Hours)	5	25	0	0	-20	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: The burden to respondents has decreased from 25 hours to 5 hours, a decrease of 20 hours. NRC’s initial estimate was based on receiving requests from all current staff who wished to request a medical exception to the COVID-19 vaccine mandate. In the future, NRC anticipates newly hired employees may need to complete this form, but current staff should not need to complete it again unless they initially requested a postponement and need to request another postponement. In addition, the number of forms received from current NRC employees was less than anticipated.

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Annual Cost to Federal Government: $5,760

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.     Yes

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.     Yes

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? Yes

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Common Form ICR:  No

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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: 03/28/2022

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