View RCF  - OIRA Conclusion

202206-3038-001CF
Active 05/31/2025
CFTC
3206-0277 202202-3206-002
Certification of Vaccination Form
RCF New
 Approved without change   06/09/2022
Retrieve Notice of Action (NOA) 06/08/2022
The CFTC makes this self-attest form available to visitors and contractors who access the CFTC headquarters, local and regional office buildings--where events take place, work needs to be performed, and/or agency services are offered.
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask Wearing
 $0
Thuy Dinh 202 418-5128 tdinh@cftc.gov

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Certification of Vaccination Common Form 13,200 440 11,883 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 13,200 0 0 13,200 0 0
Annual Time Burden (Hours) 440 0 0 440 0 0
Annual Cost Burden (Dollars) 11,883 0 0 11,883 0 0

Yes
Miscellaneous Actions
No
50 people who come daily to the agency buildings x 260 working days per year = 13,000 annually. 4 onsite events annually, with 50 attendees at each event = 200. Total annual ## of onsite respondents = 13,200 Time burden per response/respondent = 2 minutes Total annual time burden: 13,200 x 2 minutes = 26,400 minutes = 440 hours