View RCF - OIRA Conclusion

RCF ID: 202108-3015-001CF	Previous RCF ID:
Status: Active	Expiration Date: 02/28/2022
Agency/Subagency: DFC	Agency Tracking No: DFC-019
Host OMB Control No: 3206-0277	Host ICR Reference No: 202108-3206-001

Title: Vaccine Status Form for Contractors & Visitors

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/13/2021
Terms of Clearance:

Description of Agency Usage: The form will be used by Visitors (i.e. General Public or Federal employees at other agencies) and DFC contractors. Contractors and Visitors will have to retain (once completed) to show as requested for entry.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Joanna Reynolds 202 357-3979 joanna.reynolds@dfc.gov

Common Form Information Collections (IC) in this RCF:

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.	Form Name

RCF Summary of Burden:

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	200	200
Annual Time Burden (Hours)	7	7
Annual Cost Burden (Dollars)	162	162

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: Due to Government-wide COVID Safety protocol this new attestation form for Vaccination Status was created, formalizing an additional burden.