Contractor Personnel and Visitor Certification of Vaccination

Forms and Documents

Document Name	Status
Form DD 3150 Contractor Personnel and Visitor Certification of Vaccination Form and Instruction	Modified
0704-0613_Sample Email_11.23.2021.docx Supplementary Document	2021-12-02
0704-0613_SSA_2.24.22.docx Supporting Statement A	2022-02-25

IC Document Collections

IC ID	Document Title	Status
248989	Contractor Personnel and Visitor Certification of Vaccination Form and Instruction	Modified

ICR Details

OMB Control No: 0704-0613	ICR Reference No: 202110-0704-012
Status: Received in OIRA	Previous ICR Reference No: 202108-0704-008
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Contractor Personnel and Visitor Certification of Vaccination
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/25/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2022
Responses	1,200,000	3,500,000
Time Burden (Hours)	40,000	116,667
Cost Burden (Dollars)	1,080,000	3,150,000

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Abstract: This information is being requested in order to promote the safety of individuals in Federal buildings and on DoD installations, consistent with the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force and guidance from the CDC and the Occupational Safety and Health Administration. This information will be used by DoD staff charged with implementing and enforcing workplace safety protocols and is required for ensuring compliance with the requirement for attestation by all civilian employees, on-site contractors, and official visitors. Vaccination status for Military Service members will be obtained by alternate means using DoD’s Individual Medical Readiness system.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 72590	12/22/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 8006	02/11/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Contractor Personnel and Visitor Certification of Vaccination	DD 3150	Contractor Personnel and Visitor Certification of Vaccination

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ICR Summary of Burden

	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	1,200,000	3,500,000	0	-2,300,000	0	0
Annual Time Burden (Hours)	40,000	116,667	0	-76,667	0	0
Annual Cost Burden (Dollars)	1,080,000	3,150,000	0	-2,070,000	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden has decreased due to a decrease in respondents.

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Annual Cost to Federal Government: $5,562,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/25/2022

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