Information Collection

Certification of Vaccination Common Form

IC 249030 under ICR 202205-0503-001CF · OMB 3206-0277.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0277 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPM 5062 Certification Vaccination Employee Certification of Vaccination Common Form	Form and Instruction
Form CV2 Certification of Vaccination Common Form Certification of Vaccination Common Form	Form and Instruction
OPM 5062 Certification Vaccination Employee CertificationVaccinationEmployeesFinal.pdf	Form and Instruction
CV2 Certification of Vaccination Common Form CertificationofVaccinationCommonFormredline (pb 5.23.22)final.docx	Form and Instruction

IC Title:

Certification of Vaccination Common Form

Agency IC Tracking Number:

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
Form and Instruction	OPM 5062				Yes	Yes	Fillable Fileable Signable
Form and Instruction	CV2				Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,000	0	30,000
Annual IC Time Burden (Hours)	900	0	900
Annual IC Cost Burden (Dollars)	27,006	2,646	24,360

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].