Information Collection

Certification of Vaccination Common Form

IC 248768 under ICR 202108-2700-001CF · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
3206-0277 Certification of Vaccination Common Form CertificationVaccinationPRAv6.pdf	Form

IC Title:

Certification of Vaccination Common Form

Agency IC Tracking Number:

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

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title: NASA 10HIMS Health Information Management System

FR Citation: 85 FR 79224

Number of Respondents: 38,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	38,500	38,500
Annual IC Time Burden (Hours)	1,283	1,283
Annual IC Cost Burden (Dollars)	31,262	31,262

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.