Information Collection

Contractor Personnel and Visitor Certification of Vaccination

IC 248989 under ICR 202110-0704-012 · OMB 0704-0613.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 3150 Contractor Personnel and Visitor Certification of Vaccination	Form and Instruction
DD 3150 Contractor Personnel and Visitor Certification of Vaccin dd3150 draft 20220224.pdf	Form and Instruction
DD 3150 Contractor Personnel and Visitor Certification of Vaccin dd3150 draft 20220401.PDF	Form and Instruction
0704-0613_60-Day FRN DD Form 3150.docx 60 Day FRN draft	IC Document
0704-0613_60-Day FRN DD Form 3150.docx 60 Day FRN draft	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	DD 3150	Contractor Personnel and Visitor Certification of Vaccination	dd3150 draft 20220401.PDF		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,200,000	-2,300,000	3,500,000
Annual IC Time Burden (Hours)	40,000	-76,667	116,667
Annual IC Cost Burden (Dollars)	1,080,000	-2,070,000	3,150,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
60 Day FRN draft	0704-0613_60-Day FRN DD Form 3150.docx	12/16/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.