COVID-19 Vaccine Attestation Form for Non-paid Employees

ICR 202111-3060-004

OMB: 3060-1297

Federal Form Document

IC Document Collections
ICR Details
202111-3060-004
Received in OIRA
FCC OMD-FO
COVID-19 Vaccine Attestation Form for Non-paid Employees
New collection (Request for a new OMB Control Number)   No
Emergency 11/19/2021
11/19/2021
  Requested Previously Approved
6 Months From Approved
25 0
6 0
0 0

Pursuant to Executive Order 14043, Federal employees must be fully vaccinated against COVID-19 by November 22, 2021. To ensure compliance with this mandate, the FCC is requiring employees to complete and submit an electronic form attesting to their current vaccination status. For some special categories of individuals who perform (or will perform) work for the agency but are not considered employees, however, the FCC is required to obtain OMB approval prior to collecting such information. These include incoming employees, unpaid interns, unpaid legal fellows, individuals performing work for the FCC pursuant to an Intergovernmental Personnel Agreement, participants in advisory committees, and possibly other similar classes of individuals who are not on the FCC payroll but are performing work for the agency.
The Federal Communications Commission (Commission or FCC) requests Office of Management and Budget (OMB) approval to submit the information collection described herein under the “emergency processing” provisions of the Paperwork Reduction Act (PRA) of 1995, 5 CFR 1320.13. The Commission is requesting clearance for a new information collection entitled [3060-XXXX], Vaccination Attestation and Documentation, FCC Form 5644. For the reasons explained below, We respectfully request OMB approval for this new information collection at the earliest possible time. The information collection requirements to be reported under this new collection are the result of requirements imposed by an Executive Order issued by President Biden regarding mandatory COVID-19 vaccination among Federal employees. On September 9, 2021, President Biden issued Executive Order 14043 to protect the health and safety of the Federal workforce and to promote the efficiency of the civil service. Pursuant to the Executive Order and implementing guidance, the Federal Communications Commission (FCC) informed its workforce that, other than in limited circumstances where a reasonable accommodation is legally required, all employees need to be fully vaccinated against COVID-19 by November 22, 2021, regardless of where they are working. To ensure compliance with this mandate, the FCC is requiring employees to complete and submit an electronic form attesting to their current vaccination status. For some special categories of individuals who perform (or will perform) work for the agency but are not considered employees, however, the FCC is required to obtain OMB approval prior to collecting such information. These include incoming employees, unpaid interns, unpaid legal fellows, individuals performing work for the FCC pursuant to an Intergovernmental Personnel Agreement, participants in advisory committees, and possibly other similar classes of individuals who are not on the FCC payroll but are performing work for the agency.

EO: EO 14043 Name/Subject of EO: Requiring Coronavirus Disease 2019 Vaccination for Federal Employees
  
None

Not associated with rulemaking

No

2
IC Title Form No. Form Name
Federal Government FCC Form 5644 VACCINATION AND ATTESTATION DOCUMENTATION FORM
Individuals or Households FCC Form 5644 VACCINATION AND ATTESTATION DOCUMENTATION 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 25 0 0 25 0 0
Annual Time Burden (Hours) 6 0 0 6 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
This is a new information collection resulting in a program change/increase of 25 respondents, 25 responses, and 6 total estimated burden hours.

No
    Yes
    Yes
No
No
No
No
Warren Firschein 202 418-0844 [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.
11/19/2021


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