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View RCF - OIRA Conclusion
RCF ID:
202205-3015-001CF
Previous RCF ID:
202108-3015-002CF
Status:
Active
Expiration Date:
05/31/2025
Agency/Subagency:
DFC
Agency Tracking No:
DFC-019
Host OMB Control No:
3206-0277
Host ICR Reference No:
202202-3206-002
Title:
Vaccine Status Form for Contractors & Visitors
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 form will be used by Visitors (i.e. General Public or Federal employees at other agencies) and DFC contractors. Contractors and Visitors will have to retain (once completed) to show as requested for entry.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Joanna Reynolds 202 357-3979 joanna.reynolds@dfc.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
200
6
180
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
200
200
0
0
0
0
Annual Time Burden (Hours)
6
6
0
0
0
0
Annual Cost Burden (Dollars)
180
162
0
0
18
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: