Information Collection

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

IC 250289 under ICR 202111-1902-002 · OMB 1902-0320.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1902-0320 can be found here:

Documents and Forms

Document Name Document Type
Form FERC Form No. 1000 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT Form and Instruction
FERC Form No. 1000 REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINAT 1000_Medical Exception to the COVID-19 Vaccination Requirement 1192021.pdf Form and Instruction
1000 Request for a Medical Exception to the COVID-19 Vaccinat FERC Form No. 1000.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	REQUEST FOR A MEDICAL EXCEPTION TO THE COVID-19 VACCINATION REQUIREMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1000	Request for a Medical Exception to the COVID-19 Vaccination Requirement	FERC Form No. 1000.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: FERC SORN-24	FR Citation: 86 FR 64923

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.