202109-3076-001CF RCF OMB: 3206-0277
OMB.report
OMB 3206-0277
RCF 202109-3076-001CF
( RCF New )
Array
(
[refNbr] => 202109-3076-001CF
[obm] => 3206-0277
[icr] => 202108-3206-003
[status] => Active
[agency] => FMCS
[title] => Certification of Vaccination
[typeRCF] => RCF New
[oiraAction] => Approved without change
[oiraNOA] => 362911
[termsOfClearance] =>
[previousRCF] =>
[agencyTrackingNo] =>
[conclusionDate] => 2021-10-07
[dateReceived] => 2021-10-07
)
Document
View RCF
- OIRA Conclusion
RCF ID: 202109-3076-001CFPrevious RCF ID:
Status:
Active
Expiration Date: 02/28/2022
Agency/Subagency: FMCSAgency 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:
10/07/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/07/2021
Terms of Clearance:
Description of Agency Usage:
The Agency will use the form to give to visitors and contractors to complete prior to entry of FMCS Offices.
Authorizing Statute(s):
US Code:
5 USC 1101 et seq.
Name of Law: OFFICE OF PERSONNEL MANAGEMENT
5 USC 7901 et seq.
Name of Law: SERVICES TO EMPLOYEES
Annual Cost to Federal Government: $5
Agency Contact:
Sarah Cudahy 202 606-8090 [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
306
10
248
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
306
0
0
306
0
0
Annual Time Burden (Hours)
10
0
0
10
0
0
Annual Cost Burden (Dollars)
248
0
0
248
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:
Pursuant to EO 13991 and OMB Guidance, the Agency is required to request this information to ensure the safety of federal employees and the public.