View RCF - OIRA Conclusion

Title: Certification of Vaccination Common Form

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/25/2021
	Date Received in OIRA: 08/25/2021
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 IMLS 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: Connie Bodner 202 653-4636 cbodner@imls.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	100	100
Annual Time Burden (Hours)	3	3
Annual Cost Burden (Dollars)	81	81

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: No change.