Regulatory Collection Filing

Certification of Vaccination

RCF 202108-3095-001CF · Host ICR 202108-3206-003 · OMB 3206-0277

RCF Summary

Host OMB Control No.	3206-0277
Host ICR Reference No.	202108-3206-003
Agency/Subagency	NARA
Status	Active
Type of RCF	RCF New
OIRA Conclusion Action	Approved without change
Date Received in OIRA	2021-08-31
Conclusion Date	2021-08-31
Related Links	OMB 3206-0277 · ICR 202108-3206-003 · Retrieve Notice of Action (NOA)

RCF Details

View RCF - OIRA Conclusion

RCF ID: 202108-3095-001CF	Previous RCF ID:
Status: Active	Expiration Date: 02/28/2022
Agency/Subagency: NARA	Agency Tracking No:
Host OMB Control No: 3206-0277	Host ICR Reference No: 202108-3206-003

Title: Certification of Vaccination

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/31/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/31/2021
Terms of Clearance:

Description of Agency Usage: This is for contractors and visitors only

Authorizing Statute(s): None

Annual Cost to Federal Government: $0
Agency Contact: Tamee Fechhelm 301-837-3204 [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	1,000,000	33,333	812,000	Form	3206-0277	Certification of Vaccination Common Form
				Form and Instruction	OPM 5062	Certification Vaccination Employee
				Form and Instruction	3206-0277	Certification Vaccination PRA

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	1,000,000	1,000,000
Annual Time Burden (Hours)	33,333	33,333
Annual Cost Burden (Dollars)	812,000	812,000

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: This is a new information collection (Certification of Vaccination common form) that National Archives and Records Administration (NARA) wishes to use for contractors and public visitors as soon as approval is granted.