Request for Medical Exemption to the COIVD-19 Vaccination Requirement Form

Request for a Medical Exemption to the COVID-19 Vaccination Requirement Form

OMB: 2105-0577

IC ID: 250528

Information Collection (IC) Details

View Information Collection (IC)

Request for Medical Exemption to the COIVD-19 Vaccination Requirement Form
 
No New
 
Mandatory
 
5 CFR 1320.13

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1320.13 Request for Medical Exemption for the COIV-19 Vaccination Requirements Form Request for Medical Exemption to COVID-19 Vaccination Form.pdf Yes Yes Fillable Printable

Transportation Ground Transportation

 

4,000 0
   
Federal Government
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,000 0 4,000 0 0 0
Annual IC Time Burden (Hours) 8,000 0 8,000 0 0 0
Annual IC Cost Burden (Dollars) 2,320 0 2,320 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy