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: Vaccination Form for use by contractors and visitors to the Federal Communications Commission.

Authorizing Statute(s): None

Annual Cost to Federal Government:
Agency Contact: Cathy Williams 202 418-2918 cathy.williams@fcc.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		920	28	828	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		920	28	828	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	920	920	0
Annual Time Burden (Hours)	28	31	-3
Annual Cost Burden (Dollars)	828	747	81

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: