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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1000 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT	Form and Instruction	Modified	Repair queued
2022-05641 Federal Register 60 Day.pdf	Supplementary Document	Uploaded 2022-05-25	Repair queued
FERC-1000 60-day Notice 3-11-22.docx	Supplementary Document	Uploaded 2022-05-25	Repair queued
2022-11038 30 Day Notice Published FR.pdf	Supplementary Document	Uploaded 2022-05-25	Missing upstream
Final_FERC-1000 30-Day Notice_5_17_2022.docx	Supplementary Document	Uploaded 2022-05-25	Repair queued
Final_FERC 1000 Supp. Statement.docx	Supporting Statement A	Uploaded 2022-05-25	Repair queued
1000_EO13164_00-19323.pdf	Supplementary Document	Uploaded 2021-11-10	Repair queued
1000_29USC791.docx	Supplementary Document	Uploaded 2021-11-10	Repair queued
1000_eCFR __ 29 CFR Part 1614 -- Federal Sector Equal Employment Opportunity.pdf	Supplementary Document	Uploaded 2021-11-10	Repair queued
1000_2021-01766_EO maskwearing1-20-21.pdf	Supplementary Document	Uploaded 2021-11-10	Repair queued
1000_Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees _ The White House.pdf	Supplementary Document	Uploaded 2021-11-10	Repair queued
Letter seeking emergency processing 11 8 2021.pdf	Supplementary Document	Uploaded 2021-11-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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: 202205-1902-009
Status: Received in OIRA	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: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/25/2022

table that charts list comparision

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

---

Abstract: The purpose of this information collection request is to allow the Commission to collect information from individuals applying for a medical exception to the COVID-19 Vaccination Requirement as specified in Part 2 of FERC Form No. 1000.

---

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

---

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

---

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

---

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

table that charts list of burden

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

---

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	24	24	0	0	0	0
Annual Time Burden (Hours)	12	12	0	0	0	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:

---

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

---

Common Form ICR:  No

---

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: 05/25/2022

---