OMB control number

Request for a Medical Exception to the COVID-19 Vaccination Requirement

OMB 3240-0040 · SSS.

OMB 3240-0040

Consistent with Executive Order 14043, of September 9, 2021, “Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, and included within the Safer Federal Workforce Task Force Guidance mandating all Federal employees be vaccinated by November 22, 2021, the Selective Service System (SSS) has established specific safety protocols for individuals fully vaccinated and not fully vaccinated against coronavirus disease 2019 (COVID-19). Individuals who are not fully vaccinated against COVID-19 by November 22, 2021, or who choose not to provide this information will be required to comply with applicable OMB, OPM and SSS guidance for individuals not fully vaccinated against COVID-19, including wearing masks regardless of the transmission rate in a given area, physical distancing, regular screening testing, and adhering to applicable travel requirements. SSS employees may request an exemption on the basis of a medical condition or circumstance. Exemptions will be granted in limited circumstances and only where legally required. The Medical Exception Form will be provided directly to the individuals who are requesting a medical exemption.

The latest form for Request for a Medical Exception to the COVID-19 Vaccination Requirement expires 2026-07-31 and is listed under ICR 202201-3240-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Federal Register 30 day Form 750 Medical Exception.pdf Supplementary Document
FR Notice Form 750.pdf Supplementary Document
SUPPORTING STATEMENT for Medical Exception Form 2-23-22.docxSupporting Statement A
SSS SORN FR Notice 1-10-22.docx Supplementary Document
Published FR Notice.pdf Supplementary Document
Emergency letter ICR.pdf Supplementary Document
SSS Form 750.pdf Supplementary Document
Requiring Coronavirus Disease 2019 Vaccination for Federal Employees Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202202-3240-001 Revision of a currently approved collection 2022-05-16
202201-3240-001 New collection (Request for a new OMB Control Number) 2022-01-13 Approved with change