layout table

View RCF  - OIRA Conclusion

Reginfo record details
Reginfo record details
202108-3141-003CF 202108-3141-002CF
Active 02/28/2022
NIGC
3206-0277 202108-3206-003
Reginfo record details
Title: Certification of Vaccine Form (NIGC)
Reginfo record details
RCF Recertification
 Approved   08/26/2021
Retrieve Notice of Action (NOA) 08/26/2021
Reginfo record details
The NIGC will use this form to prevent the spread of COVID-19 and to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce.
Reginfo record details
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
EO: EO 12196 Name/Subject of EO: Occupational Safety and Health Program for Federal Employees
US Code: 5 USC Chapters 11 and 79
Reginfo record details
 
Agency Contact: Tim Osumi 202 632-7054 [email protected]

table that charts list of ICs
IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 100 3 81 Form 3206-0277 Certification of Vaccination Common Form
Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction 3206-0277 Certification Vaccination PRA

table that charts list of burden
  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 100 100 0 0 0 0
Annual Time Burden (Hours) 3 3 0 0 0 0
Annual Cost Burden (Dollars) 81 81 0 0 0 0