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View RCF - OIRA Conclusion
RCF ID:
202109-3045-001CF
Previous RCF ID:
Status:
Active
Expiration Date:
05/31/2022
Agency/Subagency:
CNCS
Agency Tracking No:
Host OMB Control No:
3206-0277
Host ICR Reference No:
202108-3206-003
Title:
Vaccination Attestation Form for 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:
AmeriCorps will require employees to complete and submit this form. AmeriCorps will require contractors and visitors to complete this form and produce it upon request.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Amy Borgstrom 202 606-6930 aborgstrom@cns.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
27
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
0
0
800
0
0
Annual Time Burden (Hours)
27
0
0
27
0
0
Annual Cost Burden (Dollars)
650
0
0
650
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:
The burden has increased with the addition of 500 employees and 300 contractors/visitors to the RCF.