OMB control number
COVID-19 Vaccination Requests for Waiver
OMB 1405-0246 ยท STATE/AFA.
OMB 1405-0246
Per guidance from the Safer Federal Workforce Task Force, an agency may be required to provide a reasonable accommodation to employees or prospective employees who communicate to the agency that they are not vaccinated against COVID-19 because of a medical reason or disability, or because of a sincerely held religious belief, practice, or observance.
The latest form for COVID-19 Vaccination Requests for Waiver expires 2026-07-31 and is listed under ICR 202206-1405-004.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form DS-5159 REQUEST FOR A RELIGIOUS ACCOMMODATION TO THE COVID-19 VACCINATION REQUIREMENT | Form and Instruction |
 Form DS-5158 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT | Form and Instruction |
 Legal Authorities 1405-0246.docx | Supplementary Document |
| 30 Day supporting statement - COVID Vacc Requests for Waiver.docx | Supporting Statement A |
| Emergency PRA Letter - Signed.pdf | Supplementary Document |
 REQUEST FOR A RELIGIOUS ACCOMMODATION TO THE COVID-19 VACCINATION REQUIREMENT |
Form and Instruction |
| REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202206-1405-004 | Revision of a currently approved collection | 2022-06-24 | Approved without change | |
| 202112-1405-009 | New collection (Request for a new OMB Control Number) | 2021-12-15 | Approved without change |
OMB Details
REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT
Federal Enterprise Architecture: Health - Immunization Management
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form DS-5158 | REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.