OMB control number
Request for a Medical Exemption to the COVID-19 Vaccination Requirement Form
OMB 2105-0577 ยท DOT/OST.
OMB 2105-0577
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202111-2105-001 | New collection (Request for a new OMB Control Number) | 2021-11-23 | Approved without change |