Individuals or Households

COVID-19 Vaccine Attestation Form for Non-paid Employees

OMB: 3060-1297

IC ID: 250336

Information Collection (IC) Details

View Information Collection (IC)

Individuals or Households OMD-IO
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction FCC Form 5644 VACCINATION AND ATTESTATION DOCUMENTATION FORM Vaccination Status Survey Home - Vaccination Status Survey.pdf Yes Yes Fillable Fileable Signable

General Government Central Fiscal Operations

FCC/OMD-33, Ensuring Workplace Health and Safety in Response to a Public Health Emergency  86 FR 32674

140 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 140 0 0 128 0 12
Annual IC Time Burden (Hours) 35 0 0 32 0 3
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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