Regulatory Collection Filing

Certification of Vaccination for Visitors and On-Site Contractors

RCF 202205-0420-001CF · Host ICR 202202-3206-002 · OMB 3206-0277

RCF Summary

Request for correction metadata
Host OMB Control No.	3206-0277
Host ICR Reference No.	202202-3206-002
Agency/Subagency	PEACE
Status	Active
Type of RCF	RCF Recertification
OIRA Conclusion Action	Approved
Date Received in OIRA	2022-05-24
Conclusion Date	2022-05-24
Agency Tracking No.	PC-3011
Related Links	OMB 3206-0277 · ICR 202202-3206-002 · Previous RCF 202109-0420-001CF · Retrieve Notice of Action (NOA)

Reginfo record details
Title: Certification of Vaccination for Visitors and On-Site Contractors

Reginfo record details
Type of RCF: RCF Recertification
OIRA Conclusion Action: Approved	Conclusion Date: 05/24/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/24/2022
Terms of Clearance:

Reginfo record details
Description of Agency Usage: Visitors and on-site contractors will carry the completed form on their persons. They can show the form when needed.

Reginfo record details
Authorizing Statute(s): EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing

Reginfo record details
Annual Cost to Federal Government: $81
Agency Contact: Virginia Burke 202 692-1887 [email protected]

Common Form Information Collections (IC) in this RCF:

table that charts list of ICs
IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Certification of Vaccination Common Form		100	3	90	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		100	3	90	Form and Instruction	CV2	Certification of Vaccination Common Form

RCF Summary of Burden:

table that charts list of burden
	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	100	100	0
Annual Time Burden (Hours)	3	3	0
Annual Cost Burden (Dollars)	90	81	9

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: