View RCF  - Agency Submission

202108-3155-001CF
Received in OIRA 02/28/2022
DNFSB 202108-3155-001CF
3206-0277 202108-3206-001
Certification of Vaccination
RCF New
The form will be used by DNFSB contractors and visitors to document their vaccination status. They will retain the completed form to show as requested for entry.
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask Wearing
 $100
James Biggins 202 694-7014 [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 100 0 0 100 0 0
Annual Time Burden (Hours) 3 0 0 3 0 0
Annual Cost Burden (Dollars) 81 0 0 81 0 0

Yes
Miscellaneous Actions
No
This is a new collection required to comply with EO 13991