OMB control number

COVID-19 Vaccination Requests for Waiver

OMB 1405-0246 · STATE/AFA.

OMB 1405-0246

Per guidance from the Safer Federal Workforce Task Force, an agency may be required to provide a reasonable accommodation to employees or prospective employees who communicate to the agency that they are not vaccinated against COVID-19 because of a medical reason or disability, or because of a sincerely held religious belief, practice, or observance.

The latest form for COVID-19 Vaccination Requests for Waiver expires 2026-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DS-5159 REQUEST FOR A RELIGIOUS ACCOMMODATION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction
Form DS-5158 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction
Legal Authorities 1405-0246.docx Supplementary Document
30 Day supporting statement - COVID Vacc Requests for Waiver.docx Supporting Statement A
Emergency PRA Letter - Signed.pdf Supplementary Document
REQUEST FOR A RELIGIOUS ACCOMMODATION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction
REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction

All Historical Document Collections

202206-1405-004 Approved without change	Revision of a currently approved collection	2022-06-24
202112-1405-009 Approved without change	New collection (Request for a new OMB Control Number)	2021-12-15

OMB Details

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

Federal Enterprise Architecture: Health - Immunization Management

Form DS-5158

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

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.