Information Collection

Student Vaccination Certification and Testing Consent

IC 249488 under ICR 202202-1205-002 · OMB 1205-0548.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0548 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx	Other-Attestation
1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx	Other-Attestation

IC Title:

Student Vaccination Certification and Testing Consent

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Attestation			1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/GOVT-2 Job Corps Student Records

FR Citation: 81 FR 25765

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80,000	40,000	40,000
Annual IC Time Burden (Hours)	26,400	13,200	13,200
Annual IC Cost Burden (Dollars)	0	0	0

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.