Certification of Vaccination Common Form

Certification of Vaccination Form

Documents and Forms

Document Name Document Type
Form OPM 5062 Certification of Vaccination Common Form Form and Instruction
OPM 5062 Certification Vaccination Employee CertificationVaccinationEmployeesFinal.pdf Form and Instruction
CV2 Certification of Vaccination Common Form CertificationofVaccinationCommonFormredline (pb 5.23.22)final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Certification of Vaccination Common Form	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

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

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,200	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	13,200	13,200
Annual IC Time Burden (Hours)	440	440
Annual IC Cost Burden (Dollars)	11,883	11,883

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.