USAID PERSONAL SERVICES
CONTRACTOR REPORT VACCINATION FORM
New
collection (Request for a new OMB Control Number)
No
Emergency
12/06/2021
11/23/2021
Requested
Previously Approved
6 Months From Approved
3,000
0
750
0
0
0
As required by Executive Order 14042
USAID is implementing the federal COVID-19 vaccination mandate and
evaluating compliance by Personal Services Contractors (PSCs). In
order to determine compliance, USAID must collect medical
information including the number of vaccination doses received,
dates, and type of vaccination. Respondents will be USAID
PSCs.
USAID must evaluate PSC
vaccination documentation to ensure that the information provided
complies with Executive Order 14042. USAID proposes to utilize a
Report Vaccination Form to collect medical information that will
help determine whether PSCs are in compliance with the federal
COVID-19 vaccination mandate. The template form is the same as the
form used by U.S. Direct Hire (USDH) staff and ensures USAID has
the most accurate and current information on contractors’
vaccination status.
EO: EO
14042 Name/Subject of EO: Ensuring Adequate COVID Safety Protocols
for Federal Contractors
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.