NIH COVID-19 Vaccination Status Form

ICR 202203-0925-002

OMB: 0925-0771

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form
New
Form and Instruction
Unchanged
Supplementary Document
2022-03-15
Supplementary Document
2022-03-14
Supplementary Document
2022-03-14
Supporting Statement A
2022-03-14
IC Document Collections
ICR Details
0925-0771 202203-0925-002
Received in OIRA 202110-0925-001
HHS/NIH
NIH COVID-19 Vaccination Status Form
Revision of a currently approved collection   No
Regular 03/16/2022
  Requested Previously Approved
36 Months From Approved 03/31/2022
102,000 31,000
8,499 2,583
0 0

The NIH now has a mandatory vaccination requirement that affects several thousand staff. We have been providing contractors, tenants, fellows, and other staff access to testing and vaccines during this pandemic. The information to be collected is needed to ensure we have the vaccination details for our staff (e.g., those providing essential services to the NIH via use agreements, visiting scientists, fellows and contractors, food service providers, and our three separate childcare providers) to comply with Executive Order 14042, Executive Order 14043, and U.S. Department of Health and Human Services (HHS) policy to mandate COVID-19 vaccinations for patient-facing health care staff. This revision request includes two new forms as NIH is implementing a building entry protocol where all people, federal government employees, contractors, patients, and visitors, will walk up to a door and scan a QR code with their phone and answer questions about Covid exposure every day.

EO: EO 13991 Name/Subject of EO: Safer Federal Workforce Task Force
  
None

Not associated with rulemaking

  86 FR 66319 11/22/2021
87 FR 14544 03/15/2022
No

  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 102,000 31,000 0 71,000 0 0
Annual Time Burden (Hours) 8,499 2,583 0 5,916 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Adjustments have occurred since this submission was approved under “emergency “procedures. The increase in the burden of 5,916 hours is due to the addition of two new forms as NIH is implementing a building entry protocol where ALL people, feds, contractors, patients, and visitors, will walk up to a door and scan a QR code with their phone and answer screening questions about Covid exposure every day.

$117,135
No
    Yes
    Yes
No
No
No
Yes
Tawanda Abdelmouti 240 276-5530 ta401@nih.gov

  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.
03/16/2022


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