NASA COVID-19 Vaccine Attestation Form

ICR 202109-2700-001

OMB:

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2021-09-08
Supplementary Document
2021-09-08
Supporting Statement A
2021-09-08
IC Document Collections
ICR Details
202109-2700-001
Received in OIRA
NASA
NASA COVID-19 Vaccine Attestation Form
New collection (Request for a new OMB Control Number)   No
Emergency 09/10/2021
09/08/2021
  Requested Previously Approved
6 Months From Approved
56,500 0
1,695 0
45,765 0

Consistent with guidance from the Centers for Disease Control and Prevention (CDC), and Executive Order 13991, Protecting the Federal Workforce and Requiring Mask-Wearing (Jan. 20, 2021), NASA is establishing specific safety protocols for fully vaccinated people and not fully vaccinated people, respectively. In order to implement these controls, NASA has created an electronic COVID-19 Vaccine Attestation Form to be completed by all NASA civil servants, contractors, and site visitors. Individuals who disclose that they are fully vaccinated may comply with agency guidance for fully vaccinated individuals; those who are unvaccinated, are not fully vaccinated, or who choose not to provide this information will be required to comply with CDC and agency guidance for not fully vaccinated individuals, including wearing masks regardless of the transmission rate in a given area, physical distancing, regular testing, and adhering to applicable travel requirements.
Pursuant to Office of Management and Budget (OMB) procedures established at 5 C.F.R. Part 1320, Controlling Paperwork Burdens on the Public, I request that the proposed information collection, the NASA Certification of Vaccination, OMB Control No. 2700-NEW, be processed as an Emergency Clearance Request in accordance with 5. C.F.R. § 1320.13, Emergency Processing. I have determined that this information must be collected prior to the time periods established under Part 1320 of the regulations and that this information is essential to implement agencies’ health and safety measures included within recent Centers for Disease Control and Prevention and Safer Federal Workforce Task Force Guidance. Government agencies have an urgent need to request attestation of vaccination status from individuals entering Federal buildings and workspaces. Applying regular Paperwork Reduction Act clearance procedures is likely to cause harm because of the threat of COVID-19 exposure and transmission. As this request for approval concerns an urgent safety need, NASA is seeking OMB’s approval to waive the need for the Federal Register Notices otherwise required by 5 C.F.R. 1320.5(a)(1)(iv) and 1320.8(d)(1) prior to publication and implementation of this disclosure.

EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
   EO: EO 13994 Name/Subject of EO: Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats
  
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
NASA COVID-19 Vaccine Attestation Form

  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 56,500 0 0 56,500 0 0
Annual Time Burden (Hours) 1,695 0 0 1,695 0 0
Annual Cost Burden (Dollars) 45,765 0 0 45,765 0 0
Yes
Miscellaneous Actions
No
This is a new collection.

$1,080
No
    Yes
    Yes
No
No
No
Yes
Claire Little 650 604-2826 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/08/2021


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