View RCF - OIRA Conclusion

Title: Vaccination Attestation Form for 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: 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	24	720	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		800	24	720	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	800	800	0
Annual Time Burden (Hours)	24	27	-3
Annual Cost Burden (Dollars)	720	650	70

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: