Request for a Medical Exemption to the COVID-19 Vaccination Requirement Form

OMB 0690-0036

Latest Forms, Documents, and Supporting Material

Document Name
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All Historical Document Collections

202204-0690-001 Approved without change	Extension without change of a currently approved collection	2022-04-28
202110-0690-001 Approved with change	New collection (Request for a new OMB Control Number)	2021-10-26