KSC COVID-19 Vaccine Scheduling Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
COVID Vaccine Registration Supporting Statement.docx	Supporting Statement A	Uploaded 2021-06-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
247700	KSC COVID-19 Vaccine Scheduling Application	Other-Registration	New

ICR Details

OMB Control No:	ICR Reference No: 202106-2700-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: NASA	Agency Tracking No:
Title: KSC COVID-19 Vaccine Scheduling Application
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/08/2021
Date Submitted to OIRA: 06/01/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	3,336	0
Time Burden (Hours)	278	0
Cost Burden (Dollars)	11,076	0

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Abstract: 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.

Emergency Justfication: 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.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 28915	05/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

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ICR Summary of Burden

table that charts list of burden

	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

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $1,127

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

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/01/2021

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