Information Collection

Certification of Vaccination Common Form

IC 248751 under ICR 202108-3206-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
3206-0277 Certification of Vaccination Common Form CertificationVaccinationPRAv6.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

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

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	1,218	1,218

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.