Information Collection

Certification of Vaccination Common Form

IC 272660 under ICR 202411-0910-001CF · OMB 3206-0277.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OPM 5062 Certification Vaccination Employee Certification of Vaccination Common Form	Form and Instruction
Form CV2 Certification of Vaccination Common Form 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

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OPM 5062				Yes	Yes	Fillable Fileable Signable
Form and Instruction	CV2				Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	7,202	7,202

Documents for IC

table that charts IC Documents
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.

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