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Certification of Vaccination Common Form
Certification of Vaccination Common Form
OMB: 3206-0277
IC ID: 248751
OMB.report
OPM
OMB 3206-0277
ICR 202108-3206-001
IC 248751
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0277 can be found here:
2024-11-26 - RCF New
2022-06-08 - RCF New
Documents and Forms
Document Name
Document Type
Form 3206-0277
Certification of Vaccination Common Form
Form
3206-0277 Certification of Vaccination Common Form
CertificationVaccinationPRAv6.pdf
Form
3206-0277 Certification of Vaccination Common Form
CertificationVaccinationPRAv6.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Certification of Vaccination Common Form
Agency IC Tracking Number:
Is this a Common Form?
Yes
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Executive Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,500
0
1,500
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
1,218
0
1,218
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.