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View RCF - OIRA Conclusion
RCF ID:
202205-0420-001CF
Previous RCF ID:
202109-0420-001CF
Status:
Active
Expiration Date:
05/31/2025
Agency/Subagency:
PEACE
Agency Tracking No:
PC-3011
Host OMB Control No:
3206-0277
Host ICR Reference No:
202202-3206-002
Title:
Certification of Vaccination for Visitors and On-Site Contractors
Type of RCF:
RCF Recertification
OIRA Conclusion Action:
Approved
Conclusion Date:
05/24/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/24/2022
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
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Certification of Vaccination Common Form
100
3
90
Form and Instruction
OPM 5062
Certification Vaccination Employee
Form and Instruction
CV2
Certification of Vaccination Common Form
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
100
100
0
0
0
0
Annual Time Burden (Hours)
3
3
0
0
0
0
Annual Cost Burden (Dollars)
90
81
0
0
9
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: