Objectives: This study sought to determine the specific processes required for obtaining religious and philosophical exemptions to school immunization laws.
Methods: State health department immunization program managers in the 48 states that offer nonmedical exemptions were surveyed. Categories were assigned to reflect the complexity of the procedure within a state for obtaining an exemption.
Results: Sixteen of the states delegated sole authority for processing exemptions to school officials. Nine states had written policies informing parents who seek an exemption of the risks of not immunizing. The complexity of the exemption process, in terms of paperwork or effort required, was inversely associated with the proportion of exemptions field.
Conclusions: In many states, the process of claiming a nonmedical exemption requires less effort than fulfilling immunization requirements.