Home OMB 3206-0277 ICR 202202-3206-002 RCF 202205-0970-001CF Regulatory Collection Filing
Certification of Vaccination Form RCF 202205-0970-001CF · 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 HHS/ACF Status Received in OIRA Type of RCF RCF New OIRA Conclusion Action View RCF focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; Date Received in OIRA 1969-12-31 Conclusion Date 1969-12-31 Agency Tracking No. ACF Related Links OMB 3206-0277 · ICR 202202-3206-002
RCF Details
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RCF ID: 202205-0970-001CFPrevious RCF ID:
Status:
Received in OIRA
Expiration Date: 05/31/2025
Agency/Subagency: HHS/ACFAgency Tracking No: ACF
Host OMB Control No: 3206-0277Host ICR Reference No: 202202-3206-002
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Title: Certification of Vaccination Form
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Type of RCF: RCF New
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Description of Agency Usage:
ACF will use this form to collect vaccination status from visitors and contractors to ACF headquarters, local and regional office buildings, and other spaces where services are provided or events take place.
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Authorizing Statute(s):
None
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Annual Cost to Federal Government:
Agency Contact:
Molly Buck 202 205-4724 [email protected]
Common Form Information Collections (IC) in this RCF:
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IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
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Total Request
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
1,000
0
0
1,000
0
0
Annual Time Burden (Hours)
33
0
0
33
0
0
Annual Cost Burden (Dollars)
900
0
0
900
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 request for use of the Certification of Vaccination Common Form by ACF.