OMB control number
Request For A Medical Exception To The Covid-19 Vaccination Requirement
OMB 3048-0058 · EXIMBANK.
OMB 3048-0058
Government-wide policy requires all Federal employees, as defined in 5 U.S.C. § 2105, to be vaccinated against COVID-19, with exceptions only as required by law. Employees may seek a legal exception to the vaccination requirement due to a disability, using the form.
The latest form for Request For A Medical Exception To The Covid-19 Vaccination Requirement expires 2026-09-30 and is listed under ICR 202202-3048-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form EIB 21-03 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT | Form and Instruction |
| EXIM Emergency Letter_signed.pdf | Supporting Statement B |
 RA for medical exception Supporting Statement November 2021 .docx | Supporting Statement A |
 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202202-3048-006 | Extension without change of a currently approved collection | 2022-03-01 | Approved without change | |
| 202111-3048-010 | New collection (Request for a new OMB Control Number) | 2021-12-01 | Approved without change |