Regulatory Collection Filing

Certification of Vaccination

RCF 202110-1557-001CF · Host ICR 202108-3206-003 · OMB 3206-0277

RCF Summary

Request for correction metadata
Host OMB Control No.	3206-0277
Host ICR Reference No.	202108-3206-003
Agency/Subagency	TREAS/OCC
Status	Active
Type of RCF	RCF New
OIRA Conclusion Action	Approved without change
Date Received in OIRA	2021-10-04
Conclusion Date	2021-10-04
Related Links	OMB 3206-0277 · ICR 202108-3206-003 · Retrieve Notice of Action (NOA)

RCF Details

View RCF - OIRA Conclusion

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RCF ID: 202110-1557-001CF	Previous RCF ID:
Status: Active	Expiration Date: 02/28/2022
Agency/Subagency: TREAS/OCC	Agency Tracking No:
Host OMB Control No: 3206-0277	Host ICR Reference No: 202108-3206-003

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Title: Certification of Vaccination

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Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/04/2021
Terms of Clearance:

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Description of Agency Usage: The purpose of this form is to take steps to prevent the spread of COVID-19, to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce.

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Authorizing Statute(s): US Code: 12 USC 1 et seq. Name of Law: The National Bank Act

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Annual Cost to Federal Government:
Agency Contact: Kristin Merritt 202 649-5585

Common Form Information Collections (IC) in this RCF:

table that charts list of ICs
IC Title	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Certification of Vaccination Common Form	2,320	77	1,884	Form	3206-0277	Certification of Vaccination Common Form
				Form and Instruction	OPM 5062	Certification Vaccination Employee
				Form and Instruction	3206-0277	Certification Vaccination PRA

RCF Summary of Burden:

table that charts list of burden
	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	2,320	2,320
Annual Time Burden (Hours)	77	77
Annual Cost Burden (Dollars)	1,884	1,884

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: The purpose of this form is to take steps to prevent the spread of COVID-19, to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce.