OMB control number
NIH COVID-19 Vaccination Status Form
OMB 0925-0771 ยท HHS/NIH.
OMB 0925-0771
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202206-0925-002 | No material or nonsubstantive change to a currently approved collection | 2022-06-23 | Approved without change | |
| 202203-0925-002 | Revision of a currently approved collection | 2022-03-16 | Approved without change | |
| 202110-0925-001 | No material or nonsubstantive change to a currently approved collection | 2021-10-05 | Approved with change | |
| 202108-0925-005 | New collection (Request for a new OMB Control Number) | 2021-09-01 | Approved with change |