202110-3235-001CF RCF OMB: 3206-0277
OMB.report
OMB 3206-0277
RCF 202110-3235-001CF
( RCF New )
Array
(
[refNbr] => 202110-3235-001CF
[obm] => 3206-0277
[icr] => 202108-3206-003
[status] => Active
[agency] => SEC
[title] => Certification of Vaccination Common Form
[typeRCF] => RCF New
[oiraAction] => Approved without change
[oiraNOA] => 366385
[termsOfClearance] =>
[previousRCF] =>
[agencyTrackingNo] => 270-826
[conclusionDate] => 2021-10-12
[dateReceived] => 2021-10-12
)
Document
View RCF
- OIRA Conclusion
RCF ID: 202110-3235-001CFPrevious RCF ID:
Status:
Active
Expiration Date: 02/28/2022
Agency/Subagency: SECAgency Tracking No: 270-826
Host OMB Control No: 3206-0277Host ICR Reference No: 202108-3206-003
Title: Certification of Vaccination Common Form
Type of RCF: RCF New
OIRA Conclusion Action: Approved without changeConclusion Date:
10/12/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/12/2021
Terms of Clearance:
Description of Agency Usage:
SEC will require employees to complete and submit this form. SEC will require contractors and visitors to complete this form and produce it upon request.
Authorizing Statute(s):
None
Annual Cost to Federal Government:
Agency Contact:
John Pezzullo 202 551-8118 pezzulloj@sec.gov
Common Form Information Collections (IC) in this RCF:
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Certification of Vaccination Common Form
3,737
125
3,034
Form
3206-0277
Certification of Vaccination Common Form
Form and Instruction
OPM 5062
Certification Vaccination Employee
Form and Instruction
3206-0277
Certification Vaccination PRA
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
3,737
0
0
3,737
0
0
Annual Time Burden (Hours)
125
0
0
125
0
0
Annual Cost Burden (Dollars)
3,034
0
0
3,034
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:
The burden increased in alignment with the anticipated number of respondents.