Contractor Personnel and Visitor Certification of Vaccination

ICR 202110-0704-012

OMB: 0704-0613

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-12-02
Supporting Statement A
2022-02-25
IC Document Collections
ICR Details
0704-0613 202110-0704-012
Received in OIRA 202108-0704-008
DOD/DODDEP
Contractor Personnel and Visitor Certification of Vaccination
Revision of a currently approved collection   No
Regular 02/25/2022
  Requested Previously Approved
36 Months From Approved 02/28/2022
1,200,000 3,500,000
40,000 116,667
1,080,000 3,150,000

This information is being requested in order to promote the safety of individuals in Federal buildings and on DoD installations, consistent with the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force and guidance from the CDC and the Occupational Safety and Health Administration. This information will be used by DoD staff charged with implementing and enforcing workplace safety protocols and is required for ensuring compliance with the requirement for attestation by all civilian employees, on-site contractors, and official visitors. Vaccination status for Military Service members will be obtained by alternate means using DoD’s Individual Medical Readiness system.

None
None

Not associated with rulemaking

  86 FR 72590 12/22/2021
87 FR 8006 02/11/2022
No

1
IC Title Form No. Form Name
Contractor Personnel and Visitor Certification of Vaccination DD 3150 Contractor Personnel and Visitor Certification of Vaccination

  Total Request 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 1,200,000 3,500,000 0 -2,300,000 0 0
Annual Time Burden (Hours) 40,000 116,667 0 -76,667 0 0
Annual Cost Burden (Dollars) 1,080,000 3,150,000 0 -2,070,000 0 0
No
Yes
Miscellaneous Actions
The burden has decreased due to a decrease in respondents.

$5,562,000
No
    Yes
    Yes
No
No
No
Yes
LaTarsha Yeargins 571 372-2089 latarsha.r.yeargins.ctr@mail.mil

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/25/2022


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