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OMB Control No: 3240-0040	ICR Reference No: 202202-3240-001
Status: Received in OIRA	Previous ICR Reference No: 202201-3240-001
Agency/Subagency: SSS	Agency Tracking No:
Title: Request for a Medical Exception to the COVID-19 Vaccination Requirement
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 05/16/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2025
Responses	8	8
Time Burden (Hours)	20	20
Cost Burden (Dollars)	0	0

Annual Cost to Federal Government: $872

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: Betty Lou Wingo 703 605-4005 BettyLou.Wingo@sss.gov