View RCF  - OIRA Conclusion

Active 02/28/2022
3206-0277 202108-3206-003
Certification of Vaccination
 Approved without change   10/07/2021
Retrieve Notice of Action (NOA) 10/07/2021
The Agency will use the form to give to visitors and contractors to complete prior to entry of FMCS Offices.
US Code: 5 USC 1101 et seq. Name of Law: OFFICE OF PERSONNEL MANAGEMENT
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 7901 et seq. Name of Law: SERVICES TO EMPLOYEES
Sarah Cudahy 202 606-8090 [email protected]

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

Miscellaneous Actions
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.