View RCF - OIRA Conclusion

Title: Certification of COVID-19 Vaccination Status

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/18/2021
	Date Received in OIRA: 08/18/2021
Terms of Clearance:

Description of Agency Usage: Given that the health and safety of employees, contractors, and visitors at the U.S. Merit Systems Protection Board (MSPB) is our highest priority, MSPB is using this form to ascertain the COVID-19 vaccination status of its contractors and visitors to ensure that the appropriate safety protocols are followed depending on vaccination status and Federal health and safety guidelines.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Fon Muttamara 202 254-4772 fon.muttamara@mspb.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	1,500	1,500
Annual Time Burden (Hours)	50	50
Annual Cost Burden (Dollars)	1,218	1,218

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: Not applicable