KSC COVID-19 Vaccine Scheduling Application

ICR 202106-2700-001

OMB:

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2021-06-01
IC Document Collections
ICR Details
202106-2700-001
Received in OIRA
NASA
KSC COVID-19 Vaccine Scheduling Application
New collection (Request for a new OMB Control Number)   No
Emergency 06/08/2021
06/01/2021
  Requested Previously Approved
6 Months From Approved
3,336 0
278 0
11,076 0

Kennedy Space Center (KSC) has been tasked by National Aeronautics and Space Administration (NASA) to prepare to provide COVID-19 vaccines to a prioritized set of employees. These vaccines could be provided to KSC by either the State of Florida Department of Health (via the Florida State Health Online Tracking System (SHOTS) program) or directly by the Federal Government. Employee data is required by the State of Florida to be uploaded to the Florida SHOTS website within 24 hours of vaccination. This data is also required by NASA to be entered into the Agency’s CORITY electronic health records system, and subsequently be provide to the Centers for Disease Control and Prevention (CDC). Eventbrite will be used to gather a subset of this data electronically directly from the employee during registration in lieu of manual entry based on a completed paper form.
This collection is directly related to the distribution of COVID-19 vaccines to NASA employees (civil servants and contractors) affiliated with the Kennedy Space Center. Because COVID vaccinations are an urgent and timely matter, emergency clearance is being requested.

None
None

Not associated with rulemaking

86 FR 28915 05/28/2021
No

1
IC Title Form No. Form Name
KSC COVID-19 Vaccine Scheduling Application

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,336 0 0 3,336 0 0
Annual Time Burden (Hours) 278 0 0 278 0 0
Annual Cost Burden (Dollars) 11,076 0 0 11,076 0 0
Yes
Miscellaneous Actions
No
This is a new collection.

$1,127
No
    Yes
    Yes
No
No
No
Yes
Claire Little 650 604-2826 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/01/2021


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