NASA will be creating an electronic version of the common form -- preserving all questions, formats, and accompanying language found on the common form -- to be used to capture vaccination information from agency civil servants, contractors, and affiliates. The number of respondents in this RCF (38,500) reflects NASA's contractors and affiliates only; civil servants are not included in this figure. NASA's electronic version will not add or remove questions from the common form, and the collected information will be stored and managed in the Electronic Health Record System, which is covered by SORN NASA 10HIMS (Health Information Management System).
None
$1,500
Claire Little 650 604-2826 claire.a.little@nasa.gov
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
38,500
0
0
38,500
0
0
Annual Time Burden (Hours)
1,283
0
0
1,283
0
0
Annual Cost Burden (Dollars)
31,262
0
0
31,262
0
0
Yes
Miscellaneous Actions
No
NASA has not used this Common Form before. As such, the previous burden was $0.