View RCF - OIRA Conclusion

Title: Certification of Vaccination Common 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: SEC will require employees to complete and submit this form. SEC 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: John Pezzullo 202 551-8118 pezzulloj@sec.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		3,737	112	3,364	Form and Instruction	OPM 5062	Certification Vaccination Employee
Certification of Vaccination Common Form		3,737	112	3,364	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	3,737	3,737	0
Annual Time Burden (Hours)	112	125	-13
Annual Cost Burden (Dollars)	3,364	3,034	330

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: