OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

NIH COVID-19 Vaccination Status Form

OMB 0925-0771 · HHS/NIH.

OMB 0925-0771

Latest Forms, Documents, and Supporting Material

Document Name
Form 3 Building Access Form Form and Instruction
Form 2 Screening Questionnaire Form
Form 1 NIH COVID-19 Vaccination Status Form Form and Instruction
1b COVID19VaccinationStatusForm_2022-06-16.pdf Supplementary Document
1a COVID19VaccinationStatusForm_2022-06-16 - Markup of Changes.pdf Supplementary Document
Change Request Memo 0925-0771.docx Justification for No Material/Nonsubstantive Change
pub 30day FRN2022-05475.pdf Supplementary Document
Attachment 3PiaFrm_Privacy Module NSAT Annual Review Submited AA_2021.rtf Supplementary Document
Attachment 2 PIA - NIDDK On-Site Web and Apps 8-4-2021.pdf Supplementary Document
Support_Statement A_NIHCOVIDVacStatusForm.docx Supporting Statement A
Building Access Form Form and Instruction
Screening Questionnaire Form
NIH COVID-19 Vaccination Status Form Form and Instruction

All Historical Document Collections

202206-0925-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-06-23
202203-0925-002 Approved without change	Revision of a currently approved collection	2022-03-16
202110-0925-001 Approved with change	No material or nonsubstantive change to a currently approved collection	2021-10-05
202108-0925-005 Approved with change	New collection (Request for a new OMB Control Number)	2021-09-01