202205-3235-001CF RCF OMB: 3206-0277
OMB.report
OMB 3206-0277
RCF 202205-3235-001CF
( RCF Recertification )
Array
(
[refNbr] => 202205-3235-001CF
[obm] => 3206-0277
[icr] => 202202-3206-002
[status] => Active
[agency] => SEC
[title] => Certification of Vaccination Common Form
[typeRCF] => RCF Recertification
[oiraAction] => Approved
[oiraNOA] => 421680
[termsOfClearance] =>
[previousRCF] => 202110-3235-001CF
[agencyTrackingNo] => 270-826
[conclusionDate] => 2022-05-24
[dateReceived] => 2022-05-24
)
Document
View RCF
- OIRA Conclusion
RCF ID: 202205-3235-001CFPrevious RCF ID: 202110-3235-001CF
Status:
Active
Expiration Date: 05/31/2025
Agency/Subagency: SECAgency Tracking No: 270-826
Host OMB Control No: 3206-0277Host ICR Reference No: 202202-3206-002
Title: Certification of Vaccination Common 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:
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
112
3,364
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
3,737
3,737
0
0
0
0
Annual Time Burden (Hours)
112
125
0
0
-13
0
Annual Cost Burden (Dollars)
3,364
3,034
0
0
330
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: