Supporting Statement A_Certification of Vaccination Final

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Supporting Statement for Certification of Vaccination

1. Part A: Justification

DOE F 231.2, Certification of Vaccination Contractors

OMB No. 1910-NEW

December 2021

U.S. Department of Energy

Washington, DC 20585

Table of Contents

Part A: Justification i

A.1. Legal Justification 2

A.2. Needs and Uses of Data 2

A.3. Use of Technology 3

A.4. Efforts to Identify Duplication 3

A.5. Provisions for Reducing Burden on Small Businesses 3

A.6. Consequences of Less-Frequent Reporting 3

A.7. Compliance with 5 CFR 1320.5 3

A.8. Summary of Consultations Outside of the Agency 4

A.9. Payments or Gifts to Respondents 4

A.10. Provisions for Protection of Information 4

A.11. Justification for Sensitive Questions 5

A.12A. Estimate of Respondent Burden Hours 5

A.12B. Estimate of Annual Cost to Respondent for Burden Hours 5

A.13. Other Estimated Annual Cost to Respondents 6

A.14. Annual Cost to the Federal Government 6

A.15. Reasons for Changes in Burden 6

A.16. Collection, Tabulation, and Publication Plans 6

A.17. OMB Number and Expiration Date 7

A.18. Certification Statement 7

A.1. Legal Justification

Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the information collection.

Consistent with guidance from the Centers for Disease Control and Prevention (CDC), the Department of Energy (DOE) is establishing specific safety protocols for fully vaccinated Support Service Contractor Employees and not fully vaccinated Support Service Contractor Employees.  Support service contractor employees who disclose that they are fully vaccinated must 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.

DOE is authorized to collect the information pursuant to Executive Order 13991, Protecting the Federal Workforce and Requiring Mask-Wearing (Jan. 20, 2021).

A.2. Needs and Uses of Data

Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection

This information is being requested, collected, and maintained in order to promote the safety of Federal buildings, the Federal workforce, and others on site at agency facilities consistent with the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. Specifically, this information will be used by DOE staff charged with implementing and enforcing workplace safety protocols.

DOE intends to collect the information via DOE F 231.2 located at MyEnergy. The form will display an OMB Control Number and expiration date, as well as a PRA Burden Disclosure Statement and a Privacy Act Statement. Respondents will have the option to show proof of vaccination or negative PCR tests upon entering DOE facilities, or to voluntarily complete the form in the online portal. Respondents who opt to complete the form will be asked to select a work location to include specification of Departmental Element, Organizational placement, sub-organization (if applicable), and Duty Location, and to enter Vaccine Details to include the type of vaccine received, the dates and location of the doses and the healthcare professional or clinic site where the vaccine was administered. Respondents will be asked to attach supporting documentation with the response.

While the information collected is intended to be used primarily for internal purposes, in limited circumstances it may be necessary to disclose the information externally, to physicians, the U.S. Department of Labor, various state departments of labor and industry groups, and contractors. A complete list of the routine uses can be found in the system of records notices associated with this collection of information, DOE-33, Personnel Medical Records, and DOE-51, Employee and Visitor Access Control Records, 74 Fed. Reg. 993, 1032 (January 9, 2009).

A.3. Use of Technology

Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.

The Department will collect the information using electronic forms. Onsite support service contractor employees will be required to complete the electronic form via MyEnergy. Respondents unable to log in to MyEnergy will have the option to submit a PDF fillable form for submission via email. DOE anticipates 100% of responses will be submitted electronically, with 90% submitted through MyEnergy, and 10% submitted via email.

A.4. Efforts to Identify Duplication

Describe efforts to identify duplication.

Similar information certified by the respondents is not available from other sources.

A.5. Provisions for Reducing Burden on Small Businesses

If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

This information collection request has no identified impact on small businesses and organizations.

A.6. Consequences of Less-Frequent Reporting

Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

Onsite support service contractor employees who opt to complete the form will do so one time, unless their vaccination status changes. Less frequent collection would inhibit DOE’s ability to meet the mandates of the Safer Federal Workforce Task Force and DOE’s specific established safety protocols for fully vaccinated people and not fully vaccinated people, respectively.  

A.7. Compliance with 5 CFR 1320.5

Explain any special circumstances that require the collection to be conducted in a manner inconsistent with OMB guidelines:

(a) requiring respondents to report information to the agency more often than quarterly;

(b) requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it;

(c) requiring respondents to submit more than an original and two copies of any document;

(d) requiring respondents to retain records, other than health, medical government contract, grant-in-aid, or tax records, for more than three years;

(e) in connection with a statistical survey, that is not designed to product valid and reliable results that can be generalized to the universe of study;

(f) requiring the use of statistical data classification that has not been reviewed and approved by OMB;

(g) that includes a pledge of confidentially that is not supported by authority established in stature of regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or

(h) requiring respondents to submit proprietary trade secrets, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information’s confidentiality to the extent permitted by law.

Individuals may be required to report information more often than quarterly if their vaccination status changes and they need to update their information. There are no other special circumstances involved in the collection of this information.

A.8. Summary of Consultations Outside of the Agency

If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency’s notice, required by 5CFR 320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken in response to the comments. Specifically address comments received on cost and hour burden. Describe efforts to consult with persons outside DOE to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or report.

Due to the expedited timeframe for collecting this information, DOE is requesting a waiver for requesting comments from the public via the Federal Register.

A.9. Payments or Gifts to Respondents

Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No gifts or payments of any kind have been provided to any individuals who are connected to this collection.

A.10. Provisions for Protection of Information

Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Personal Identifiable Information (PII) collected through this form will be retained and covered by DOE-33, Personnel Medical Records, 74 Fed. Reg. 993, 1032 (January 9, 2009). A Privacy Act Statement is included on the form.

A.11. Justification for Sensitive Questions

Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why DOE considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

This information collection includes a request for information concerning whether or not an individual has received the COVID-19 vaccination. To the extent this information is deemed sensitive by respondents, it is necessary to promote the safety of Federal buildings, and the Federal workforce, and others on site at agency facilities consistent with the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

A.12A. Estimate of Respondent Burden Hours

Provide estimates of the hour burden of the collection of information. The statement should indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, DOE should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample fewer than 10 potential respondents is desirable.

The estimated number of respondents and responses is 15,000. This estimate is based on the number of onsite support service contractor employees whose duty station was onsite before the pandemic, even if those contractor employees are not currently accessing Federal buildings daily during the COVID-19 pandemic because they are on telework or travel.  The form requires approximately 0.167 hours (or 10 minutes) for completion, to include time for reviewing the instructions, completing the response, and submitting the information to the agency. The total burden hours requested for the six-month period covered by this emergency clearance is 2,505 hours.

Table A1. Estimated Respondent Hour Burden
Form Number/Title (and/or other Collection Instrument name)	Type of Respondents	Number of Respondents	Annual Number of Responses	Burden Hours Per Response	Annual Burden Hours*	Annual Reporting Frequency
DOE F 231.2 - MyEnergy	Contractor	13,500	13,500	0.167	2,254.5	1
DOE F 231.2 - PDF	Contractor	1,500	1,500	0.167	250.5	1
TOTAL		15,000	15,000		2,505

* Totals may not add due to rounding

A.12B. Estimate of Annual Cost to Respondent for Burden Hours

Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included under ‘Annual Cost to Federal Government’.

The estimated total cost to respondents is $203,657. This is based on a fully burdened hourly wage of $81.30/hour ($58.07 per hour base rate plus a 1.4 multiplier), using the ‘Professional and related’ line item on the BLS Civilian workers table (https://www.bls.gov/news.release/ecec.t02.htm).

Table A2. Estimated Respondent Cost Burden
Type of Respondents	Total Annual Burden Hours	Hourly Wage Rate	Total Respondent Costs
DOE Contractor	2,505	$81.30	$203,657
TOTAL	2,505		$203,657

A.13. Other Estimated Annual Cost to Respondents

Provide an estimate for the total annual cost burden to respondents or recordkeepers resulting from the collection of information.

No other costs, including capital or maintenance costs, will be incurred by respondents, beyond their time.

A.14. Annual Cost to the Federal Government

Provide estimates of annualized cost to the Federal government.

The annualized cost to the Federal government for this information collection is estimated to be $232,057. This is an aggregate of contractor costs ($203,657) and costs associated with the 250 hours spent on the design, preparation, printing, and distribution of the form. Federal employee costs are estimated to be $28,400 based on an assumed fully loaded rate of $113.60 ($71 per hour base rate (GS 14/15 level personnel), plus a 1.6 multiplier).

A.15. Reasons for Changes in Burden

Explain the reasons for any program changes or adjustments reported in Items 13 (or 14) of OMB Form 83-I.

This is a new emergency collection and thus this is not applicable.

A.16. Collection, Tabulation, and Publication Plans

For collections whose results will be published, outline the plans for tabulation and publication.

This package contains no collection whose results will be published for statistical use.

A.17. OMB Number and Expiration Date

If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons why display would be inappropriate.

DOE will display the OMB Control number and expiration date upon OMB’s approval of the information collection.

A.18. Certification Statement

Explain each exception to the certification statement identified in Item 19 of OMB Form 83-I.

The Department is not requesting any exceptions to the Certification Statement.