Information Collection

Certification of Vaccination Common Form

IC 248838 under ICR 202108-1225-002CF · OMB 3206-0277.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0277 can be found here:

Documents and Forms

Document Name Document Type
Form 3206-0277 Certification of Vaccination Common Form Form
3206-0277 Certification of Vaccination Common Form CertificationVaccinationPRAv6.pdf Form
OPM 5062 Certification Vaccination Employee CertificationVaccinationEmployeesFinal.pdf Form and Instruction
3206-0277 Certification Vaccination PRA CertificationVaccinationPRAfinal.pdf Form and Instruction

Information Collection (IC) Details

View RCF Information Collection (IC)

IC Title:	Certification of Vaccination Common Form	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3206-0277	Certification of Vaccination Common Form	CertificationVaccinationPRAv6.pdf	No		Printable Only
Form and Instruction	OPM 5062	Certification Vaccination Employee	CertificationVaccinationEmployeesFinal.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3206-0277	Certification Vaccination PRA	CertificationVaccinationPRAfinal.pdf	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,000	0	4,000
Annual IC Time Burden (Hours)	120	-13	133
Annual IC Cost Burden (Dollars)	3,248	0	3,248

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.