Home OMB 3206-0277 ICR 202108-3206-003 RCF 202108-0412-003CF Regulatory Collection Filing
Certification of Vaccination Form RCF 202108-0412-003CF · Host ICR 202108-3206-003 · OMB 3206-0277
RCF Summary Request for correction metadata Host OMB Control No. 3206-0277 Host ICR Reference No. 202108-3206-003 Agency/Subagency AID Status Received in OIRA Type of RCF RCF New OIRA Conclusion Action View RCF focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; Date Received in OIRA 1969-12-31 Conclusion Date 1969-12-31 Related Links OMB 3206-0277 · ICR 202108-3206-003
RCF Details
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View RCF
- Agency Submission
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RCF ID: 202108-0412-003CFPrevious RCF ID:
Status:
Received in OIRA
Expiration Date: 02/28/2022
Agency/Subagency: AIDAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-003
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Title: Certification of Vaccination Form
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Type of RCF: RCF New
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Description of Agency Usage:
The purpose of this collection is to prevent the spread of COVID-19, to protect the health and safety of Federal employees, onsite contractors, and visitors and individuals interacting with the Federal workforce. The form will be used for the attestation of vaccine status by Federal employees, contractors, and visitors.
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Authorizing Statute(s):
None
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Annual Cost to Federal Government:
Agency Contact:
Taniesha Tolbert 202 712-1217 [email protected]
Common Form Information Collections (IC) in this RCF:
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IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
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Total Request
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
5,384
0
0
5,384
0
0
Annual Time Burden (Hours)
179
0
0
179
0
0
Annual Cost Burden (Dollars)
4,372
0
0
4,372
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
New Collection