Request for Medical Exception to COVID-19 Vaccination Requirement

OMB 1212-0075

Latest Forms, Documents, and Supporting Material

Document Name
Form Part I Request for Medical Exception to COVID-19 Vaccination Requirement Form and Instruction
Vaccine Requirement Exemption ICR Supporting Statement 2022.03.docx Supporting Statement A
Request for Medical Exception to COVID-19 Vaccination Requirement Form and Instruction

All Historical Document Collections

202204-1212-001 Approved without change	Revision of a currently approved collection	2022-04-25
202111-1212-001 Approved without change	New collection (Request for a new OMB Control Number)	2021-11-23