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

Forms and Documents

Document Name	Status
Form 1000 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction	Modified
2022-11038 30 Day Notice Published FR.pdf Supplementary Document	2022-05-23
Final_FERC 1000 Supp. Statement.docx Supporting Statement A	2022-05-23
20220517-3052_Final_FERC-1000 30-Day Notice_5_17_2022.docx Supplementary Document	2022-05-18
2022-05641-Federal Register 60 Day FERC 1000.pdf Supplementary Document	2022-05-06
20220311-3021_FERC-1000 60-day Notice 3-11-22 (1).docx Supplementary Document	2022-05-06
1000_EO13164_00-19323.pdf Supplementary Document	2021-11-10
1000_29USC791.docx Supplementary Document	2021-11-10
1000_eCFR __ 29 CFR Part 1614 -- Federal Sector Equal Employment Opportunity.pdf Supplementary Document	2021-11-10
1000_2021-01766_EO maskwearing1-20-21.pdf Supplementary Document	2021-11-10
1000_Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees _ The White House.pdf Supplementary Document	2021-11-10

IC Document Collections

IC ID	Document Title	Status
250289	REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction	Modified

ICR Details

OMB Control No: 1902-0320	ICR Reference No: 202205-1902-003
Status: Historical Inactive	Previous ICR Reference No: 202111-1902-002
Agency/Subagency: FERC	Agency Tracking No: FERC-1000
Title: Request for a Medical Exception to the COVID-19 Vaccination Requirement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 05/24/2022
	Date Received in OIRA: 05/24/2022
Terms of Clearance: Withdrawn at Agency request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved	05/31/2022
Responses	24	0	24
Time Burden (Hours)	12	0	12
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this request of Paperwork Reduction Act (PRA) clearance is to allow the Federal Energy Regulatory Commission (FERC or Commission) to collect information from individuals applying for a medical exemption to the COVID-19 Mandatory Vaccinations as specified in Part 2 of FERC Form No. 1000. The collection of information is critical to meeting our commitments as outlined in Executive Order 14043 of September 9, 2021, Requiring Coronavirus Disease 2019 Vaccination for Federal Employees and the Safer Federal Workforce Task Force guidance.

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Authorizing Statute(s): US Code: 29 USC 791 Name of Law: Rehabilitation Act
   EO: EO 14043 Name/Subject of EO: Requiring COVID-19 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:
	87 FR 15235	03/17/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 31226	05/23/2022
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT	1000	Request for a Medical Exception to the COVID-19 Vaccination Requirement

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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:

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Annual Cost to Federal Government: $10,007

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: 05/24/2022

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