View RCF
- OIRA Conclusion
RCF ID: 202205-0412-001CFPrevious RCF ID: 202108-0412-003CF
Status:
Active
Expiration Date: 05/31/2025
Agency/Subagency: AIDAgency Tracking No:
Host OMB Control No: 3206-0277Host ICR Reference No: 202202-3206-002
Title: Certification of Vaccination Form
Type of RCF: RCF Recertification
OIRA Conclusion Action: ApprovedConclusion Date:
05/24/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/24/2022
Terms of Clearance:
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
Certification of Vaccination Common Form
5,384
162
4,847
Form and Instruction
OPM 5062
Certification Vaccination Employee
Form and Instruction
CV2
Certification of Vaccination Common Form
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
5,384
5,384
0
0
0
0
Annual Time Burden (Hours)
162
179
0
0
-17
0
Annual Cost Burden (Dollars)
4,847
4,372
0
0
475
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: