Information Collection

Certification of Vaccination

IC 248930 under ICR 202108-1910-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 231.2 Certification of Vaccination	Form and Instruction
DOE F 231.2 Certification of Vaccination Form Certification of Vaccination Form.docx	Form and Instruction
DOE F 231.2 Certification of Vaccination Form Certification of Vaccination Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DOE F 231.2	Certification of Vaccination Form	Certification of Vaccination Form.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title: DOE-33, Personnel Medical Records

FR Citation: 74 FR 993

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	2,505	2,505
Annual IC Cost Burden (Dollars)	145,766	145,766

Documents for IC

table that charts IC Documents
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.