View RCF  - OIRA Conclusion

202108-1205-002CF
Active 05/31/2022
DOL/ETA
3206-0277 202108-3206-003
Certification of Vaccination
RCF New
 Approved without change   08/30/2021
Retrieve Notice of Action (NOA) 08/27/2021
ETA will use this form to prevent the spread of COVID-19, and to protect the health and safety of all persons in DOL's Job Corps. Centers.
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
 $0
Mara Blumenthal 202 693-8538 blumenthal.mara@dol.gov

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 12,000 400 9,744 Form 3206-0277 Certification of Vaccination Common Form
Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction 3206-0277 Certification Vaccination PRA

  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 12,000 0 0 12,000 0 0
Annual Time Burden (Hours) 400 0 0 400 0 0
Annual Cost Burden (Dollars) 9,744 0 0 9,744 0 0

Yes
Miscellaneous Actions
No
The burden requested reflects ETA's projected usage of the common form for the Job Corps. contractors.