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Request for a Religious Exception to the COVID-19 Vaccine Requirement
Request for a Religious Exception to the COVID-19 Vaccine Requirement
OMB: 1557-0353
IC ID: 249970
OMB.report
TREAS/OCC
OMB 1557-0353
ICR 202203-1557-006
IC 249970
( )
Documents and Forms
Document Name
Document Type
Request for a Religious Exception to the COVID-19 Vaccine Requirement
Form
Religious Accommodation Form
religious-accommodation-request-form (1).docx
Form
Religious Accommodation Form
religious-accommodation-request-form (1).docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Request for a Religious Exception to the COVID-19 Vaccine Requirement
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
N/A
Religious Accommodation Form
religious-accommodation-request-form (1).docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Economic Development
Subfunction:
Financial Sector Oversight
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
4
0
0
0
0
4
Annual IC Time Burden (Hours)
2
0
0
0
0
2
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.
