OMB control number
Submissions Related to the COVID-19 Vaccination Requirement
OMB 3084-0170 · FTC.
OMB 3084-0170
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form Not Applicable Vaccination Certification Requirements for Prospective Employees with Federal Job Offers | Form and Instruction |
| Form Unknown Medical Certification for COVID-19 Vaccine Exception for Federal Employees | Form and Instruction |
| Medical Exception Request-letter-11_8_21.pdf | Supplementary Document |
| Medical Exception Request-Letter-11_4_21.pdf | Supplementary Document |
| Supplemental Supporting Statement for New Employee Hires-11-30-2021-FINAL.pdf | Supporting Statement A |
 Medical Certification for COVID-19 Vaccine Exception for Prospective Employees with Job Offer |
Other-Emergency Justification Letter |
| Vaccination Certification Requirements for Prospective Employees with Federal Job Offers |
Form and Instruction |
| Medical Certification for COVID-19 Vaccine Exception for Federal Employees |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202111-3084-003 | Revision of a currently approved collection | 2021-11-30 | Approved without change | |
| 202111-3084-001 | New collection (Request for a new OMB Control Number) | 2021-11-05 | Approved without change |