View RCF - OIRA Conclusion

Title: Certification Vaccination Common Form - Visitors and Contractors

Type of RCF: RCF Recertification
OIRA Conclusion Action: Approved	Conclusion Date: 08/26/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/26/2021
Terms of Clearance:

Description of Agency Usage: Certification Vaccination Common Form to be filled out by visitors and contractors prior to entering into the FDIC's facilities.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Jennifer Jones 202 551-5776 [email protected]

Common Form Information Collections (IC) in this RCF:

IC Title	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Certification of Vaccination Common Form	800	24	650	Form	3206-0277	Certification of Vaccination Common Form
				Form and Instruction	OPM 5062	Certification Vaccination Employee
				Form and Instruction	3206-0277	Certification Vaccination PRA

RCF Summary of Burden:

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	800	800	0
Annual Time Burden (Hours)	24	27	-3
Annual Cost Burden (Dollars)	650	650	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:

202108-3064-002CF