Table 1.

Ease of Exemption Classification Standards^a

Type of Requirement	Easyb	Mediumc	Difficultd
Form with parent signature required	x	X	x
Form available at school	x
Form available online	x
Form available at health department only		x	x
Parent personal statement required		x	x
Parent visit to health department required		x	x
Form must be notarized			x
Signature of state official or religious leader required			x
Yearly recertification required			x

^aAdapted from Omer SB, Pan WK, Halsey NA, et al. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. JAMA 2006;296:1757–63.

^bStates were classified as easy if they required at least 1 standard from the easy list and nothing from the medium or difficult list.

^cStates were classified as medium if they required at least 2 standards from the medium list in addition to things from the easy list. These states did not have requirements from the difficult list.

^dStates were classified as difficult if they required at least 3 standards from the difficult list in addition to anything from the medium or easy list.