Individuals or Households

Vaccination Documentation for Prospective New Employees

Documents and Forms

Document Name Document Type
FAQs_compliance_injunction_EO 14043_20220124.pdf Other-COVID-19 Compliance
FAQs_compliance_injunction_EO 14043_20220124.pdf Other-COVID-19 Compliance

Information Collection (IC) Details

IC Title:	Individuals or Households	Agency IC Tracking Number:	OMD-IO

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-COVID-19 Compliance			FAQs_compliance_injunction_EO 14043_20220124.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title: OPM/GOVT-10, Employee Medical File System Records	FR Citation: 75 FR 35099

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.