Appian Vaccination Attestation Form

Forms and Documents

Document	Type	Status	Availability
1557-0355 Appian attestation form Supporting Statement 5-16-22.docx	Supporting Statement A	Uploaded 2022-05-16	Missing upstream

IC Document Collections

IC ID	Collection	Type	Status	Form
250776	Vaccination Attestation Form	Other-Screenshots	Unchanged

ICR Details

OMB Control No: 1557-0355	ICR Reference No: 202205-1557-002
Status: Received in OIRA	Previous ICR Reference No: 202112-1557-001
Agency/Subagency: TREAS/OCC	Agency Tracking No:
Title: Appian Vaccination Attestation Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/23/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2022
Responses	250	250
Time Burden (Hours)	63	63
Cost Burden (Dollars)	0	0

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Abstract: The President, by Executive order 13991 (January 20, 2021) established the Safer Federal Workforce Task Force. The Taskforce was established to give the heads of federal agencies ongoing guidance to keep their employees safe and their agencies operating during the COVID-19 pandemic. The Taskforce issued guidance, in accordance with the President’s Executive Order 14043 (September 9, 2021), requiring federal employees to be vaccinated against COVID-19 by November 22, 2021 absent a legally required exception. The Taskforce issued guidance regarding individuals who start their government service after November 22, 2021, stating that those individuals should be fully vaccinated prior to their start date, except in limited circumstances where an accommodation is legally required. The guidance also provided that agencies should require documentation to prove vaccination status of those individuals prior to the enter on-duty date. To determine whether individuals who have been offered a position with the Office of the Comptroller of the Currency (OCC) are fully vaccinated during the onboarding process and before their enter on-duty date, in compliance with the Taskforce guidance, the OCC has developed a form in an online application (Appian vaccination attestation form). The Request form was developed, consistent with guidance issued by the Taskforce and the U.S. Department of Treasury, to gather information from employees regarding their vaccination status and proof of vaccination. The Appian vaccination attestation form will also be used to collect information from prospective employees. In order to comply with the Taskforce guidance, the information to be collected on the Appian vaccination attestation form is needed prior to the time periods established under 5 CFR part 1320. Compliance with the vaccination mandate and the Taskforce guidance is essential to protecting the health and safety of the OCC’s workforce, which is essential to the OCC’s accomplishment of its mission.

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Authorizing Statute(s): US Code: 12 USC 1 et seq. Name of Law: The National Bank Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 13042	03/08/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 31295	05/23/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Vaccination Attestation Form

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	250	250	0	0	0	0
Annual Time Burden (Hours)	63	63	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/23/2022

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