View RCF  - OIRA Conclusion

202108-1225-002CF 202108-1225-001CF
Active 05/31/2022
DOL/DM
3206-0277 202108-3206-003
Certification of Vaccination
RCF Recertification
 Approved   08/26/2021
Retrieve Notice of Action (NOA) 08/26/2021
The Department will use this form to prevent the spread of COVID-19, and to protect the health and safety of all persons in DOL buildings.
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
 
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 4,000 120 3,248 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 4,000 4,000 0 0 0 0
Annual Time Burden (Hours) 120 133 0 0 -13 0
Annual Cost Burden (Dollars) 3,248 3,248 0 0 0 0

Yes
Miscellaneous Actions
No