View RCF
- OIRA Conclusion
RCF ID: 202109-1880-001CFPrevious RCF ID:
Status:
Active
Expiration Date: 02/28/2022
Agency/Subagency: ED/OMAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-003
Title: Certification of Vaccination Form
Type of RCF: RCF New
OIRA Conclusion Action: Approved without changeConclusion Date:
09/14/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/14/2021
Terms of Clearance:
Description of Agency Usage:
ED will use this form to collect vaccination status from visitors and contractors to ED headquarters, local and regional office buildings where services are provided.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Stephanie Valentine 202 401-0526 [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
5,829
194
4,733
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
5,829
0
0
5,829
0
0
Annual Time Burden (Hours)
194
0
0
194
0
0
Annual Cost Burden (Dollars)
4,733
0
0
4,733
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 request, therefore all burden is new. This results in an increase in burden and responses of 194 hours and 5,829 responses.