View RCF  - OIRA Conclusion

202108-1103-002CF 202108-1103-001CF
Active 02/28/2022
DOJ/DOJADM
3206-0277 202108-3206-003
Vaccine Attestation Form
RCF Recertification
 Approved   08/26/2021
Retrieve Notice of Action (NOA) 08/26/2021
The Department has been directed to ask about the vaccination status of Federal employees and onsite contractors. Employees and onsite contractors must sign an attestation confirming their vaccine status. Visitors must demonstrate information on their vaccine status, unless they are entering to obtain a public service or benefit.
None
 
Melody Braswell 202 307-0890 [email protected]

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 2,000,000 60,000 1,624,000 Form 3206-0277 Certification of Vaccination Common Form
Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction 3206-0277 Certification Vaccination PRA

  Total Approved 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 2,000,000 2,000,000 0 0 0 0
Annual Time Burden (Hours) 60,000 66,667 0 0 -6,667 0
Annual Cost Burden (Dollars) 1,624,000 1,624,000 0 0 0 0

Yes
Miscellaneous Actions
No