OMB control number

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

OMB 2105-0577 · DOT/OST.

OMB 2105-0577

Latest Forms, Documents, and Supporting Material

Document Name
Form 1320.13 Request for Medical Exemption to the COIVD-19 Vaccination Requirement Form Form
Emergency Letter DOT Medical Exception Form__.docx Supplementary Document
Request for Medical Exemption to COVID-19 Vaccination Form.pdf Supplementary Document
Supporting Statement Part A _Emergency_ Request for Medical Exemption Form_112321.pdf Supporting Statement A
Request for Medical Exemption to the COIVD-19 Vaccination Requirement Form Form

All Historical Document Collections

202111-2105-001

2021-11-23