OMB control number
Medical Exception Request to the COVID-19 Vaccination Requirement
OMB 3079-0001 · FMSHRC.
OMB 3079-0001
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form FMSHRC-09-001 FMSHRC Medical Exception Request Form | Form and Instruction |
| 2022-4-28 FMSHRC Transmittal Letter to OIRA.pdf | Supplementary Document |
 2021-11-22 FMSRHC Transmittal Letter to OIRA .docx | Supplementary Document |
| 2021-11-22 FMSRHC Transmittal Letter to OIRA .docx | Supplementary Document |
| 2022-4-28 FMSHRC Transmittal Letter to OIRA.pdf | Supporting Statement A |
 FMSHRC Medical Exception Request Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202201-3079-001 | Extension without change of a currently approved collection | 2022-04-28 | Approved with change | |
| 202111-3079-001 | New collection (Request for a new OMB Control Number) | 2021-11-22 | Approved without change |