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I believe that was the case with Amazon until a couple of weeks ago.

Now your manager can no longer approve it, and even if your manager did previously approve it you might need to request approval from a higher authorisation level.

Maybe, the communication is unclear and it seems your manager doesn't get to decide. They can help you apply for an exception, but even people with medical reasons are having trouble getting approval from what I've heard. The announcement stated they expected very few exceptions to the mandate.

It's on a case by case basis, but the S-team leader (one below jassy) has to approve. This kills most cases. For typical employee this means this has to go through your boss and then 3-5 other executives.