OMB control number

Request For A Medical Exception To The Covid-19 Vaccination Requirement

OMB 3048-0058 · EXIMBANK.

OMB 3048-0058

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.

The latest form for Request For A Medical Exception To The Covid-19 Vaccination Requirement expires 2026-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form EIB 21-03 EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction
EXIM Emergency Letter_signed.pdf Supporting Statement B
RA for medical exception Supporting Statement November 2021 .docx Supporting Statement A
EIB 21-03 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction

All Historical Document Collections

202202-3048-006 Approved without change	Extension without change of a currently approved collection	2022-03-01
202111-3048-010 Approved without change	New collection (Request for a new OMB Control Number)	2021-12-01