Certification of Vaccination Common Form

⚠️ Notice: This information collection may be referencing outdated material.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
3206-0277 Certification of Vaccination Common Form CertificationVaccinationPRAv6.pdf Form
OPM 5062 Certification Vaccination Employee CertificationVaccinationEmployeesFinal.pdf Form and Instruction
3206-0277 Certification Vaccination PRA CertificationVaccinationPRAfinal.pdf Form and Instruction

Information Collection (IC) Details

View RCF Information Collection (IC)

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

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3206-0277	Certification of Vaccination Common Form	CertificationVaccinationPRAv6.pdf	No		Printable Only
Form and Instruction	OPM 5062	Certification Vaccination Employee	CertificationVaccinationEmployeesFinal.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3206-0277	Certification Vaccination PRA	CertificationVaccinationPRAfinal.pdf	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	2,320	2,320
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	1,884	1,884

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.