OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Certification of Vaccination

IC 249212 under ICR 202201-3170-001 · OMB 3170-0075.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Certification of Vaccination
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Certification of Vaccination Certification of Vaccination (10-25-2021).docx Yes Yes Fillable Fileable

Health Public Health Monitoring

CFPB.029, Public Health and Safety System  86 FR 18041

1,500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,500 0 0 0 0 1,500
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.