View RCF  - OIRA Conclusion

202205-3124-001CF 202108-3124-002CF
Active 05/31/2025
MSPB
3206-0277 202202-3206-002
Certification of COVID-19 Vaccination Status
RCF Recertification
 Approved   05/24/2022
Retrieve Notice of Action (NOA) 05/24/2022
Given that the health and safety of employees, contractors, and visitors at the U.S. Merit Systems Protection Board (MSPB) is our highest priority, MSPB is using this form to ascertain the COVID-19 vaccination status of its contractors and visitors to ensure that the appropriate safety protocols are followed depending on vaccination status and Federal health and safety guidelines.
None
 
Fon Muttamara 202 254-4772 fon.muttamara@mspb.gov

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 1,500 45 1,350 Form and Instruction OPM 5062 Certification Vaccination Employee
Form and Instruction CV2 Certification of Vaccination Common Form

  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 1,500 1,500 0 0 0 0
Annual Time Burden (Hours) 45 45 0 0 0 0
Annual Cost Burden (Dollars) 1,350 1,218 0 0 132 0

Yes
Miscellaneous Actions
No