View RCF - OIRA Conclusion

Title: Certification of Vaccination Form

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: ED will use this form to collect vaccination status from visitors and contractors to ED headquarters, local and regional office buildings where services are provided.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Stephanie Valentine 202 401-0526 stephanie.valentine@ed.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		5,829	175	5,247	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		5,829	175	5,247	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	5,829	5,829	0
Annual Time Burden (Hours)	175	194	-19
Annual Cost Burden (Dollars)	5,247	4,733	514

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: