Home OMB 3206-0277 ICR 202202-3206-002 RCF 202411-0910-001CF Regulatory Collection Filing
Certification of Vaccination Form RCF 202411-0910-001CF · Host ICR 202202-3206-002 · OMB 3206-0277
RCF Summary
Host OMB Control No. 3206-0277 Host ICR Reference No. 202202-3206-002 Agency/Subagency HHS/FDA Status Received in OIRA Type of RCF RCF New OIRA Conclusion Action (function(){var g=function(e,h,f,g){ this.get=function(a){for(var a=a+"=",c=document.cookie.split(";"),b=0,e=c.length;b=e/100?0: Date Received in OIRA 1969-12-31 Conclusion Date 1969-12-31 Related Links OMB 3206-0277 · ICR 202202-3206-002
RCF Details
View RCF
- Agency Submission
RCF ID: 202411-0910-001CFPrevious RCF ID:
Status:
Received in OIRA
Expiration Date: 05/31/2025
Agency/Subagency: HHS/FDAAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202202-3206-002
Title: Certification of Vaccination Form
Description of Agency Usage:
FDA will use this form to collect vaccination and surveillance status from visitors (and people who will work with FDA) to FDA headquarters, local and regional office buildings, and other spaces where services are provided, or events take place.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Jonna Capezzuto 301 796-3794 [email protected]
Common Form Information Collections (IC) in this RCF:
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
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
8,000
0
0
8,000
0
0
Annual Time Burden (Hours)
267
0
0
267
0
0
Annual Cost Burden (Dollars)
7,202
0
0
7,202
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 new data collection for FDA.