View RCF  - Agency Submission

202108-2700-001CF
Received in OIRA 02/28/2022
NASA
3206-0277 202108-3206-001
NASA Certification of Vaccination
RCF New
NASA will be creating an electronic version of the common form -- preserving all questions, formats, and accompanying language found on the common form -- to be used to capture vaccination information from agency civil servants, contractors, and affiliates. The number of respondents in this RCF (38,500) reflects NASA's contractors and affiliates only; civil servants are not included in this figure. NASA's electronic version will not add or remove questions from the common form, and the collected information will be stored and managed in the Electronic Health Record System, which is covered by SORN NASA 10HIMS (Health Information Management System).
None
 $1,500
Claire Little 650 604-2826 [email protected]

IC Title Status Responses Hours Dollars Document Type Form No. Form Name

  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 38,500 0 0 38,500 0 0
Annual Time Burden (Hours) 1,283 0 0 1,283 0 0
Annual Cost Burden (Dollars) 31,262 0 0 31,262 0 0

Yes
Miscellaneous Actions
No
NASA has not used this Common Form before. As such, the previous burden was $0.