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

ICR 202205-1902-009

OMB: 1902-0320

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2022-05-25
Supplementary Document
2022-05-25
Supplementary Document
2022-05-25
Supplementary Document
2022-05-25
Supporting Statement A
2022-05-25
Supplementary Document
2021-11-10
Supplementary Document
2021-11-10
Supplementary Document
2021-11-10
Supplementary Document
2021-11-10
Supplementary Document
2021-11-10
Supplementary Document
2021-11-08
IC Document Collections
ICR Details
1902-0320 202205-1902-009
Received in OIRA 202111-1902-002
FERC FERC-1000
Request for a Medical Exception to the COVID-19 Vaccination Requirement
Extension without change of a currently approved collection   No
Regular 05/25/2022
  Requested Previously Approved
36 Months From Approved 05/31/2022
24 24
12 12
0 0

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.

US Code: 29 USC 791 Name of Law: Rehabilitation Act
   EO: EO 14043 Name/Subject of EO: Requiring COVID-19 vaccination for federal employees
  
None

Not associated with rulemaking

  87 FR 15235 03/17/2022
87 FR 31226 05/23/2022
No

  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
No
No

$10,007
No
    Yes
    Yes
No
No
No
Yes
Christopher Kozler 734 239-3294 [email protected]

  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:
 
 
 
 
 
 
 
    (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.
05/25/2022


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