View RCF
- OIRA Conclusion
RCF ID: 202108-3095-001CFPrevious RCF ID:
Status:
Active
Expiration Date: 02/28/2022
Agency/Subagency: NARAAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-003
Title: Certification of Vaccination
Type of RCF: RCF New
OIRA Conclusion Action: Approved without changeConclusion 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
Status
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
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
1,000,000
0
0
1,000,000
0
0
Annual Time Burden (Hours)
33,333
0
0
33,333
0
0
Annual Cost Burden (Dollars)
812,000
0
0
812,000
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:
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.