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Certification of Vaccination

1 OMB control No. 3206-0277 Exp. Feb. 5, 2022 Certification of Vaccination The purpose of this form is to take steps to prevent the spread of COVID-19, to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce. If you fail to submit this signed attestation or any required negative COVID-19 test, you may be denied entry to a Federal facility. My Vaccination Status By checking the box below, I declare that the following statement is true: I am fully 1 The Centers for Disease control and Prevention considers an individual fully vaccinated if they are: 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson

Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and ... and do not need to undertake regular testing—please note that consistent with CDC guidance, agencies may have different protocols for fully vaccinated people ... Federal building or Federally controlled indoor worksites.

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