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View RCF - OIRA Conclusion
RCF ID:
202108-3064-002CF
Previous RCF ID:
202108-3064-001CF
Status:
Active
Expiration Date:
05/31/2022
Agency/Subagency:
FDIC
Agency Tracking No:
Host OMB Control No:
3206-0277
Host ICR Reference No:
202108-3206-003
Title:
Certification Vaccination Common Form - Visitors and Contractors
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:
Certification Vaccination Common Form to be filled out by visitors and contractors prior to entering into the FDIC's facilities.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Jennifer Jones 202 551-5776 jonesjen@sec.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
800
24
650
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
800
800
0
0
0
0
Annual Time Burden (Hours)
24
27
0
0
-3
0
Annual Cost Burden (Dollars)
650
650
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: