OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT

ICR 202111-3048-010 · OMB 3048-0058 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form EIB 21-03 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction New Repair queued
RA for medical exception Supporting Statement November 2021 .docx Supporting Statement A Uploaded 2021-12-01 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
250594 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction New
ICR Details
202111-3048-010
Received in OIRA
EXIMBANK EIB 21-03
REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT
New collection (Request for a new OMB Control Number)   No
Emergency 12/06/2021
12/01/2021
  Requested Previously Approved
6 Months From Approved
12 0
24 0
0 0
Government-wide policy requires all Federal employees, as defined in 5 U.S.C. § 2105, to be vaccinated against COVID-19, with exceptions only as required by law. Employees may seek a legal exception to the vaccination requirement due to a disability, using the form.
EXIM is requesting tan emergency approval to comply with the Government-wide policy which requires all Federal employees, as defined in 5 U.S.C. § 2105, to be vaccinated against COVID-19, with exceptions only as required by law. Employees may seek a legal exception to the vaccination requirement due to a disability, using the form below. The agency may also ask for other information, as needed. Requests for “medical accommodation” or “medical exceptions” will be treated as requests for a disability accommodation and evaluated and decided under applicable Rehabilitation Act standards for reasonable accommodation absent undue hardship to the agency.
None
None
Not associated with rulemaking
No
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12 0 0 12 0 0
Annual Time Burden (Hours) 24 0 0 24 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new Form to be used at EXIM.
$1,224
No
    Yes
    Yes
No
No
No
Yes
Bassam Doughman 202 565-3168 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/01/2021