OMB control number

NIH COVID-19 Vaccination Status Form

OMB 0925-0771 · HHS/NIH.

OMB 0925-0771

Latest forms, documents, and information collections
Document	Type
Form 3 Building Access Form	Form and Instruction
Form 3 Building Access Form	Form and Instruction
Form 2 screening questionnaire	Form
Form 2 Screening Questionnaire	Form
Form 1 NIH COVID-19 Vaccination Status Form	Form and Instruction
Form 1 NIHCOVID-19 Vaccination Status Form	Form and Instruction
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
Building Access Form	Form and Instruction
Screening Questionnaire	Form
Screening Questionnaire	Form
NIH COVID-19 Vaccination Status Form	Form and Instruction
NIH COVID-19 Vaccination Status Form	Form and Instruction
NIH COVID-19 Vaccination Status Form	Form and Instruction

Historical document collections
Reference	Filing	Received	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