OMB control number
Request for Medical Exception to COVID-19 Vaccination Requirement
OMB 1212-0075 · PBGC.
OMB 1212-0075
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form Part II Request for Medical Exception to COVID-19 Vaccination Requirement | Form and Instruction |
| Form Part I Request for Medical Exception to COVID-19 Vaccination Requirement, Part I | Form and Instruction |
| Form Part I Request for Medical Exception to COVID-19 Vaccination Requirement | Form and Instruction |
 Vaccine Requirement Exemption ICR Supporting Statement 2022.03.docx | Supporting Statement A |
 Request for Medical Exception to COVID-19 Vaccination Requirement |
Form and Instruction |
| Request for Medical Exception to COVID-19 Vaccination Requirement |
Form and Instruction |
| Request for Medical Exception to COVID-19 Vaccination Requirement |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202204-1212-001 | Revision of a currently approved collection | 2022-04-25 | Approved without change | |
| 202111-1212-001 | New collection (Request for a new OMB Control Number) | 2021-11-23 | Approved without change |