View RCF
- Agency Submission
RCF ID: 202108-0412-003CFPrevious RCF ID:
Status:
Received in OIRA
Expiration Date: 02/28/2022
Agency/Subagency: AIDAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-003
Title: Certification of Vaccination Form
Description of Agency Usage:
The purpose of this collection is to prevent the spread of COVID-19, to protect the health and safety of Federal employees, onsite contractors, and visitors and individuals interacting with the Federal workforce. The form will be used for the attestation of vaccine status by Federal employees, contractors, and visitors.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Taniesha Tolbert 202 712-1217 ttolbert@usaid.gov
Common Form Information Collections (IC) in this RCF:
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
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
5,384
0
0
5,384
0
0
Annual Time Burden (Hours)
179
0
0
179
0
0
Annual Cost Burden (Dollars)
4,372
0
0
4,372
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:
New Collection