OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202202-3048-006 · 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 Modified Repair queued
EXIM Emergency Letter_signed.pdf Supporting Statement B Uploaded 2021-12-02 Repair queued
RA for medical exception Supporting Statement November 2021 .docx Supporting Statement A Uploaded 2021-12-01 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
250594 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction Modified
ICR Details
3048-0058 202202-3048-006
Received in OIRA 202111-3048-010
EXIMBANK EIB 21-03
REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT
Extension without change of a currently approved collection   No
Regular 03/01/2022
  Requested Previously Approved
36 Months From Approved 06/30/2022
12 12
24 24
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.
None
None
Not associated with rulemaking
  86 FR 69254 12/07/2021
87 FR 10364 02/24/2022
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 12 0 0 0 0
Annual Time Burden (Hours) 24 24 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$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.
03/01/2022