OMB control number
Request for a Medical Exception to the COVID-19 Vaccination Requirement
OMB 3060-1295 ยท FCC.
OMB 3060-1295
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form FCC Form 5643 Federal Government | Form and Instruction |
| Form FCC Form 5643 Business or other for-profit | Form and Instruction |
| Form FCC Form 5643 Individuals or Households | Form and Instruction |
 3060-1295 Explanation of Non-Substantive Changes for Medical Exemption Form_12.6.21.docx | Justification for No Material/Nonsubstantive Change |
| Emergency PRA Approval Cover Letter for Collecting Info for COVID Medical Exemption Form_10.-29-21 signed.pdf | Supplementary Document |
| Emergency PRA Supporting Statement for COVID Medical Exemption (final version).docx | Supporting Statement A |
 Federal Government |
Form and Instruction |
| Business or other for-profit |
Form and Instruction |
| Individuals or Households |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202112-3060-003 | No material or nonsubstantive change to a currently approved collection | 2021-12-07 | Approved without change | |
| 202111-3060-001 | New collection (Request for a new OMB Control Number) | 2021-11-01 | Approved without change |