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

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

OMB: 3440-0002

IC ID: 250346

Information Collection (IC) Details

View Information Collection (IC)

Request for a Medical Exception to the COVID-19 Vaccination Requirement
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Request for a Medical Exception to the COVID-19 Vaccination Requirement ATTACH 1 (ODNI Form COVID-19 Med. Exemp. Request)_U.pdf Yes No Fillable Printable

Defense and National Security Strategic National and Theater Defense

ODNI-10, "Office of Intelligence Community Equal Employment Opportunity and Diversity Office (IC EEOD) Records, 80 FR 30276 (May 27, 2015)-also available at [https:/lwww.govinfo.gov/content/pkg/FR-201  15 FR 527

100 0
   
Federal Government
 
   0 %

  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 100 0 100 0 0 0
Annual IC Time Burden (Hours) 125 0 125 0 0 0
Annual IC Cost Burden (Dollars) 5,176 0 5,176 0 0 0

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