OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Medical Exception Request to the COVID-19 Vaccination Requirement

OMB 3079-0001 · FMSHRC.

OMB 3079-0001

Latest Forms, Documents, and Supporting Material

Document Name
Form FMSHRC-09-001 FMSHRC Medical Exception Request Form Form and Instruction
2022-4-28 FMSHRC Transmittal Letter to OIRA.pdf Supplementary Document
2021-11-22 FMSRHC Transmittal Letter to OIRA .docx Supplementary Document
2021-11-22 FMSRHC Transmittal Letter to OIRA .docx Supplementary Document
2022-4-28 FMSHRC Transmittal Letter to OIRA.pdf Supporting Statement A
FMSHRC Medical Exception Request Form Form and Instruction

All Historical Document Collections

202201-3079-001 Approved with change	Extension without change of a currently approved collection	2022-04-28
202111-3079-001 Approved without change	New collection (Request for a new OMB Control Number)	2021-11-22