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View RCF - OIRA Conclusion
RCF ID:
202206-0970-001CF
Previous RCF ID:
202205-0970-001CF
Status:
Active
Expiration Date:
05/31/2025
Agency/Subagency:
HHS/ACF
Agency Tracking No:
ACF
Host OMB Control No:
3206-0277
Host ICR Reference No:
202202-3206-002
Title:
Certification of Vaccination Form
Type of RCF:
RCF No material or nonsubstantive change to a currently approved collection
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/07/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/07/2022
Terms of Clearance:
Description of Agency Usage:
ACF will use this form to collect vaccination status from visitors and contractors to ACF headquarters, local and regional office buildings, and other spaces where services are provided or events take place.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Molly Buck 202 205-4724 mary.buck@acf.hhs.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
8,000
267
7,202
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
8,000
1,000
0
7,000
0
0
Annual Time Burden (Hours)
267
33
0
234
0
0
Annual Cost Burden (Dollars)
7,202
900
0
6,302
0
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:
ACF inadvertently did not include an estimate for all expected entrants to buildings/events.