Certification of Vaccination

ICR 202109-3170-002

OMB: 3170-0075

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2021-09-14
Supplementary Document
2021-09-08
IC Document Collections
IC ID
Document
Title
Status
249212 New
ICR Details
202109-3170-002
Received in OIRA
CFPB
Certification of Vaccination
New collection (Request for a new OMB Control Number)   No
Emergency 09/22/2021
09/14/2021
  Requested Previously Approved
6 Months From Approved
1,500 0
125 0
0 0

The Consumer Financial Protection Bureau (CFPB or the Bureau) is establishing safety protocols for both fully vaccinated and unvaccinated people. This information collection (e.g. the certification form) will ascertain individuals’ vaccination status in order for the Bureau to comply with Executive Order 13991 titled Protecting the Federal Workforce and Requiring Mask-Wearing. In compliance with guidance from the Centers for Disease Control and Prevention (CDC) and the Safer Federal Workforce Task Force, the Bureau is collecting this information from fully vaccinated individuals so that they can comply with Bureau safety guidelines. The Bureau is also collecting this information from partially or unvaccinated individuals so that that other measures can be implemented to enforce Bureau safety guidelines (e.g. wearing masks, physical/social distancing, regular testing, adherence to applicable travel requirements). The Bureau requests these data to promote the safety of Federal buildings, the Federal workforce, and others on site at agency facilities consistent with the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. Specifically, Bureau staff will use these data for implementing and enforcing workplace safety protocols.
On January 20, 2021, the President signed Executive Order 13991 (titled “Protecting the Federal Workforce and Requiring Mask-Wearing”) in order to stop the spread of coronavirus disease by relying on the best available data and science-based public health measures. Vaccines, masks, and other known public health measures help to reduce the spread of coronavirus when affected communities employ them. The Bureau requests the approval of this vaccination attestation to protect the Federal workforce and individuals directly interacting with the Federal workforce while ensuring continuity of government service. This attestation will collect data on the vaccination status of Federal employees, Federal contractors, and any members of the public requesting physical access to the Bureau. Failure to collect these data will result in diminished effectiveness of science-based public health measures and likely result in public harm. Per 5 Code of Federal Regulations Part 1320.13, the Bureau is requesting emergency processing of this submission due to: • The certification being essential to safe operations within the Bureau; and • The likely public harm that will result if normal clearance procedures are followed by Bureau staff.

None
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Certification of Vaccination N/A Certification of Vaccination

  Total Request 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) 125 0 0 125 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This ICR is requesting emergency processing of a new information collection. There are no program changes nor adjustments.

$0
No
    Yes
    Yes
No
No
No
Yes
Hoan Nguyen 202 435-9414

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/14/2021


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