View Information Collection (IC)

View RCF Information Collection (IC)

IC Title:	Certification of Vaccination Common Form	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3206-0277	Certification of Vaccination Common Form	CertificationVaccinationPRAv6.pdf		No		Printable Only
Form and Instruction	OPM 5062	Certification Vaccination Employee	CertificationVaccinationEmployeesFinal.pdf		Yes	Yes	Fillable Fileable Signable
Form and Instruction	3206-0277	Certification Vaccination PRA	CertificationVaccinationPRAfinal.pdf		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	3,600	0	0	0	0	3,600
Annual IC Time Burden (Hours)	108	0	0	-12	0	120
Annual IC Cost Burden (Dollars)	2,923	0	0	0	0	2,923

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.