Information Collection

Certification of Vaccination

IC 250968 under ICR 202112-1910-002 · OMB 1910-5194.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5194 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DOE F 231.2 Certification of Vaccination	Form and Instruction
DOE F 231.2 Certificate of Vaccination DOE F 231.2_Certificate of Vaccination_Contractor-MyEnergy.pdf	Form and Instruction
DOE F 231.2 Certificate of Vaccination DOE F 231.2_Certificate of Vaccination_Contractor-MyEnergy.pdf	Form and Instruction
DOE F 231.2 Certificate of Vaccination DOE F 231.2_Certificate of Vaccination_Contractor-PDF.pdf	Form and Instruction
DOE F 231.2 Certificate of Vaccination DOE F 231.2_Certificate of Vaccination_Contractor-PDF.pdf	Form and Instruction

IC Title:

Certification of Vaccination

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	DOE F 231.2	Certificate of Vaccination	DOE F 231.2_Certificate of Vaccination_Contractor-MyEnergy.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	DOE F 231.2	Certificate of Vaccination	DOE F 231.2_Certificate of Vaccination_Contractor-PDF.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	2,505	2,505
Annual IC Cost Burden (Dollars)	203,657	203,657

Documents for IC

table that charts IC Documents
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.