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OMB Control No: 0704-0619	ICR Reference No: 202111-0704-010
Status: Received in OIRA	Previous ICR Reference No: 202110-0704-007
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Request for a Medical Exemption or Delay to the COVID-19 Vaccination Requirement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 04/27/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	180,000	180,000
Time Burden (Hours)	15,000	15,000
Cost Burden (Dollars)	405,000	405,000

Annual Cost to Federal Government: $5,152,600

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

Agency Contact: LaTarsha Yeargins 571 372-2089 latarsha.r.yeargins.ctr@mail.mil