View RCF
- OIRA Conclusion
RCF ID: 202108-3124-001CFPrevious RCF ID:
Status:
Active
Expiration Date: 02/28/2022
Agency/Subagency: MSPBAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-001
Title: Certification of COVID-19 Vaccination Status
Type of RCF: RCF New
OIRA Conclusion Action: Approved without changeConclusion Date:
08/18/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/18/2021
Terms of Clearance:
Description of Agency Usage:
Given that the health and safety of employees, contractors, and visitors at the U.S. Merit Systems Protection Board (MSPB) is our highest priority, MSPB is using this form to ascertain the COVID-19 vaccination status of its contractors and visitors to ensure that the appropriate safety protocols are followed depending on vaccination status and Federal health and safety guidelines.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
Fon Muttamara 202 254-4772 fon.muttamara@mspb.gov
Common Form Information Collections (IC) in this RCF:
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
1,500
0
0
1,500
0
0
Annual Time Burden (Hours)
50
0
0
50
0
0
Annual Cost Burden (Dollars)
1,218
0
0
1,218
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:
Not applicable