202108-3155-001CF RCF OMB: 3206-0277
OMB.report
OMB 3206-0277
RCF 202108-3155-001CF
( RCF New )
Array
(
[refNbr] => 202108-3155-001CF
[obm] => 3206-0277
[icr] => 202108-3206-001
[status] => Received in OIRA
[agency] => DNFSB
[title] => Certification of Vaccination
[typeRCF] => RCF New
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[oiraNOA] => View RCF focusMeth
[termsOfClearance] =>
[previousRCF] =>
[agencyTrackingNo] => 202108-3155-001CF
[conclusionDate] => 1969-12-31
[dateReceived] => 1969-12-31
)
Document
View RCF
- Agency Submission
RCF ID: 202108-3155-001CFPrevious RCF ID:
Status:
Received in OIRA
Expiration Date: 02/28/2022
Agency/Subagency: DNFSBAgency Tracking No: 202108-3155-001CF
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-001
Title: Certification of Vaccination
Description of Agency Usage:
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.
Authorizing Statute(s):
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask Wearing
Annual Cost to Federal Government: $100
Agency Contact:
James Biggins 202 694-7014 [email protected]
Common Form Information Collections (IC) in this RCF:
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
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 collection required to comply with EO 13991