OMB control number
Request for a Medical Exemption to the COVID-19 Vaccination Requirement Form
OMB 0690-0036 ยท DOC/OS.
OMB 0690-0036
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form DOC Request for Medical Exemption Form | Form and Instruction |
 Supporting Statement Part A -Request for COVID 19 Medical Exemption Vaccination Requirement Form Extension.docx | Supporting Statement A |
| OMB Letter - Emergency Clearance Request for DOC Medical Exemption Form.pdf | Supplementary Document |
 DOC Request for Medical Exemption Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202204-0690-001 | Extension without change of a currently approved collection | 2022-04-28 | Approved without change | |
| 202110-0690-001 | New collection (Request for a new OMB Control Number) | 2021-10-26 | Approved with change |