layout table

View RCF  - OIRA Conclusion

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202205-3076-001CF 202109-3076-001CF
Active 05/31/2025
FMCS
3206-0277 202202-3206-002
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Title: Certification of Vaccination
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RCF Recertification
 Approved   05/24/2022
Retrieve Notice of Action (NOA) 05/24/2022
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The Agency will use the form to give to visitors and contractors to complete prior to entry of FMCS Offices.
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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
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 $5
Agency Contact: Sarah Cudahy 202 606-8090 [email protected]

table that charts list of ICs
IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 306 9 275 Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction CV2 Certification of Vaccination Common Form

table that charts list of burden
  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 306 306 0 0 0 0
Annual Time Burden (Hours) 9 10 0 0 -1 0
Annual Cost Burden (Dollars) 275 248 0 0 27 0