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Federal forms, ICRs, and supporting documents

Information Collection

NIH COVID-19 Vaccination Status Form

IC 249128 under ICR 202206-0925-002 · OMB 0925-0771.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

NIH COVID-19 Vaccination Status Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 NIHCOVID-19 Vaccination Status Form NIH COVID-19 Vaccination Status Form_Example-Fully-Vaccinated (2).pdf Yes Yes Fillable Fileable
Form and Instruction 1 NIH COVID-19 Vaccination Status Form 1b COVID19VaccinationStatusForm_2022-06-16.pdf Yes Yes Fillable Fileable

Health Health Care Services

09-25-0166 Radiation and Occupational Safety and Health Management Information Systems, HHS/NIH/ORS  67 FR 67042

31,000 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 31,000 0 0 0 0 31,000
Annual IC Time Burden (Hours) 2,583 0 0 0 0 2,583
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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