202205-0420-001CF
RCF
OMB: 3206-0277
Array
(
[refNbr] => 202205-0420-001CF
[obm] => 3206-0277
[icr] => 202202-3206-002
[status] => Active
[agency] => PEACE
[title] => Certification of Vaccination for Visitors and On-Site Contractors
[typeRCF] => RCF Recertification
[oiraAction] => Approved
[oiraNOA] => 421480
[termsOfClearance] =>
[previousRCF] => 202109-0420-001CF
[agencyTrackingNo] => PC-3011
[conclusionDate] => 2022-05-24
[dateReceived] => 2022-05-24
)
Document
View RCF
- OIRA Conclusion
202205-0420-001CF |
202109-0420-001CF |
Active
|
05/31/2025 |
PEACE |
PC-3011 |
3206-0277 |
202202-3206-002 |
Certification of Vaccination for Visitors and On-Site Contractors |
RCF Recertification
|
Approved |
05/24/2022
|
Retrieve Notice of Action (NOA)
|
05/24/2022
|
|
Visitors and on-site contractors will carry the completed form on their persons. They can show the form when needed.
|
EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
|
$81
|
Virginia Burke 202 692-1887 vburke@peacecorps.gov
|
|
IC Title |
Status |
Responses |
Hours |
Dollars |
Document Type |
Form No. |
Form Name |
Certification of Vaccination Common Form
|
|
100 |
3 |
90 |
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 |
100 |
100 |
0 |
0 |
0 |
0 |
Annual Time Burden (Hours) |
3 |
3 |
0 |
0 |
0 |
0 |
Annual Cost Burden (Dollars) |
90 |
81 |
0 |
0 |
9 |
0 |
Yes
|
Miscellaneous Actions
|
No
|
|
|
|
|