Student Vaccination Certification and Testing Consent

COVID-19 Symptom Tracker for Students, Emotional Wellness Form for Students, and Student Vaccination Status and Test Consent Form Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0548 can be found here:

Documents and Forms

Document Name Document Type
1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx Other-Attestation
1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx Other-Attestation

Information Collection (IC) Details

IC Title:	Student Vaccination Certification and Testing Consent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attestation			1205-0548 Attachment C COVID Vaccine Collect Form (3-14-22).docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/GOVT-2 Job Corps Student Records	FR Citation: 81 FR 25765

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80,000	40,000	40,000
Annual IC Time Burden (Hours)	26,400	13,200	13,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.