View RCF  - OIRA Conclusion

202411-0910-001CF
Historical Active 05/31/2025
HHS/FDA
3206-0277 202202-3206-002
Certification of Vaccination Form
RCF New
 Approved without change   12/02/2024
Retrieve Notice of Action (NOA) 11/26/2024
FDA will use this form to collect vaccination and surveillance status from visitors (and people who will work with FDA) to FDA headquarters, local and regional office buildings, and other spaces where services are provided, or events take place.
None
 
Jonna Capezzuto 301 796-3794 jonnalynn.capezzuto@fda.hhs.gov

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

  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 0 0 8,000 0 0
Annual Time Burden (Hours) 267 0 0 267 0 0
Annual Cost Burden (Dollars) 7,202 0 0 7,202 0 0

Yes
Miscellaneous Actions
No
This is a new data collection for FDA.