View RCF  - OIRA Conclusion

202206-0970-001CF 202205-0970-001CF
Active 05/31/2025
HHS/ACF ACF
3206-0277 202202-3206-002
Certification of Vaccination Form
RCF No material or nonsubstantive change to a currently approved collection
 Approved without change   06/07/2022
Retrieve Notice of Action (NOA) 06/07/2022
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.
None
 
Molly Buck 202 205-4724 [email protected]

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 8,000 267 7,202 Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction CV2 Certification of Vaccination Common Form

  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 8,000 1,000 0 7,000 0 0
Annual Time Burden (Hours) 267 33 0 234 0 0
Annual Cost Burden (Dollars) 7,202 900 0 6,302 0 0

Yes
Miscellaneous Actions
No
ACF inadvertently did not include an estimate for all expected entrants to buildings/events.