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Certification of Vaccination Common Form
Certification of Vaccination Form
OMB: 3206-0277
IC ID: 272660
OMB.report
HHS/FDA
OMB 3206-0277
ICR 202411-0910-001CF
IC 272660
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View RCF Information Collection (IC)
IC Title:
Certification of Vaccination Common Form
Agency IC Tracking Number:
IC Status:
New
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Executive Functions
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
8,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
8,000
0
8,000
0
0
0
Annual IC Time Burden (Hours)
267
0
267
0
0
0
Annual IC Cost Burden (Dollars)
7,202
0
7,202
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.