NASA COVID-19 Vaccine Attestation Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NASA 10HIMS SORN.pdf	Supplementary Document	Uploaded 2021-09-08	Repair queued
PRA Emergency Clearance Letter SIGNED.pdf	Supplementary Document	Uploaded 2021-09-08	Repair queued
Supporting Statement Vaccination Attestation.docx	Supporting Statement A	Uploaded 2021-09-08	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249211	NASA COVID-19 Vaccine Attestation Form	Other-Attestation Form	New

ICR Details

OMB Control No:	ICR Reference No: 202109-2700-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: NASA	Agency Tracking No:
Title: NASA COVID-19 Vaccine Attestation Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/10/2021
Date Submitted to OIRA: 09/08/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	56,500	0
Time Burden (Hours)	1,695	0
Cost Burden (Dollars)	45,765	0

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Abstract: 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.

Emergency Justfication: 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.

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Authorizing Statute(s): 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
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

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ICR Summary of Burden

table that charts list of burden

	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

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $1,080

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/08/2021

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