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View RCF - OIRA Conclusion
RCF ID:
202108-3015-002CF
Previous RCF ID:
202108-3015-001CF
Status:
Active
Expiration Date:
05/31/2022
Agency/Subagency:
DFC
Agency Tracking No:
DFC-019
Host OMB Control No:
3206-0277
Host ICR Reference No:
202108-3206-003
Title:
Vaccine Status Form for Contractors & Visitors
Type of RCF:
RCF Recertification
OIRA Conclusion Action:
Approved
Conclusion Date:
08/26/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/26/2021
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
Certification of Vaccination Common Form
200
6
162
Form
3206-0277
Certification of Vaccination Common Form
Form and Instruction
OPM 5062
Certification Vaccination Employee
Form and Instruction
3206-0277
Certification Vaccination PRA
RCF Summary of Burden:
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
200
200
0
0
0
0
Annual Time Burden (Hours)
6
7
0
0
-1
0
Annual Cost Burden (Dollars)
162
162
0
0
0
0
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: