View RCF - OIRA Conclusion

Title: Certification of Vaccination for Visitors and On-Site Contractors

Type of RCF: RCF New
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/23/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/23/2021
Terms of Clearance:

Description of Agency Usage: Visitors and on-site contractors will carry the completed form on their persons. They can show the form when needed.

Authorizing Statute(s): EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing

Annual Cost to Federal Government: $81
Agency Contact: Virginia Burke 202 692-1887 vburke@peacecorps.gov

Common Form Information Collections (IC) in this RCF:

IC Title	Responses	Hours	Dollars	Document Type	Form No.	Form Name
Certification of Vaccination Common Form	100	3	81	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	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: This may be an error on my part. We estimate 100 users, no change to what is listed on the provided Supporting Statement, # 13.