View RCF - OIRA Conclusion

Title: Certification of Vaccination

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: The purpose of this form is to take steps to prevent the spread of COVID-19, to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce.

Authorizing Statute(s): US Code: 12 USC 1 et seq. Name of Law: The National Bank Act

Annual Cost to Federal Government:
Agency Contact: Kristin Merritt 202 649-5585

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		2,320	70	2,088	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		2,320	70	2,088	Form and Instruction	CV2	Certification of Vaccination Common Form

RCF Summary of Burden:

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	2,320	2,320	0
Annual Time Burden (Hours)	70	77	-7
Annual Cost Burden (Dollars)	2,088	1,884	204

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: