layout table

View RCF  - OIRA Conclusion

Reginfo record details
Reginfo record details
202205-3155-001CF 202108-3155-002CF
Active 05/31/2025
DNFSB 202108-3155-001CF
3206-0277 202202-3206-002
Reginfo record details
Title: Certification of Vaccination
Reginfo record details
RCF Recertification
 Approved   05/24/2022
Retrieve Notice of Action (NOA) 05/24/2022
Reginfo record details
The form will be used by DNFSB contractors and visitors to document their vaccination status. They will retain the completed form to show as requested for entry.
Reginfo record details
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask Wearing
Reginfo record details
 $100
Agency Contact: James Biggins 202 694-7014 [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 100 3 90 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 100 100 0 0 0 0
Annual Time Burden (Hours) 3 3 0 0 0 0
Annual Cost Burden (Dollars) 90 81 0 0 9 0