Building Access Form

NIH COVID-19 Vaccination Status Form

OMB: 0925-0771

IC ID: 252170

Documents and Forms
Information Collection (IC) Details

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Building Access Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Building Access Form Attachment 5 Building Access Form.pdf Yes Yes Fillable Fileable

Health Health Care Services

HHS/NIH/ORS; 09-40-0002, Public Health Service (PHS) Commissioned Corps General Personnel Records and OPM/GOVT-10, Employee Medical File System Records.  81 FR 75138

35,500 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 35,500 0 35,500 0 0 0
Annual IC Time Burden (Hours) 2,958 0 2,958 0 0 0
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.

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