Certification of Vaccination Common Form

Certification of Vaccination Form

OMB: 3206-0277

IC ID: 254130

Information Collection (IC) Details

View RCF Information Collection (IC)

Certification of Vaccination Common Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction OPM 5062 Certification Vaccination Employee CertificationVaccinationEmployeesFinal.pdf Yes Yes Fillable Fileable Signable
Form and Instruction CV2 Certification of Vaccination Common Form CertificationofVaccinationCommonFormredline (pb 5.23.22)final.docx Yes Yes Fillable Printable

General Government Executive Functions

 

13,200 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 13,200 0 13,200 0 0 0
Annual IC Time Burden (Hours) 440 0 440 0 0 0
Annual IC Cost Burden (Dollars) 11,883 0 11,883 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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