# Proposed Collection; Comment Request
**AGENCY:**
The Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense (DoD).
**ACTION:**
Information collection notice.
**SUMMARY:**
In compliance with the *Paperwork Reduction Act of 1995,* the Defense Health Agency announces a proposed public information collection and seeks public comment on the provisions thereof. Comments are invited on: Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; the accuracy of the agency's estimate of the burden of the proposed information collection; ways to enhance the quality, utility, and clarity of the information to be collected; and ways to minimize the burden of the information collection on respondents, including through the use of automated collection techniques or other forms of information technology.
**DATES:**
Consideration will be given to all comments received by June 15, 2021.
**ADDRESSES:**
You may submit comments, identified by docket number and title, by any of the following methods:
*Federal eRulemaking Portal: http://www.regulations.gov.* Follow the instructions for submitting comments.
*Mail:* The DoD cannot receive written comments at this time due to the COVID-19 pandemic. Comments should be sent electronically to the docket listed above.
*Instructions:* All submissions received must include the agency name, docket number and title for this *Federal Register* document. The general policy for comments and other submissions from members of the public is to make these submissions available for public viewing on the internet at *http://www.regulations.gov* as they are received without change, including any personal identifiers or contact information.
**FOR FURTHER INFORMATION CONTACT:**
To request more information on this proposed information collection or to obtain a copy of the proposal and associated collection instruments, please write to the Office of Information Management; 4800 Mark Center Drive, Suite 03F09, Alexandria, VA 22311; ATTN: Ms. Angela Duncan or call 571-372-7574.
**SUPPLEMENTARY INFORMATION:**
*Title; Associated Form; and OMB Number:* COVID-19 Vaccine Screening and Immunization Documentation; DHA Form 207; OMB Control Number 0720-0068.
*Needs and Uses:* The Defense Health Agency (DHA) has created the DHA Form 207, “COVID-19 Vaccine Screening and Immunization Documentation” to determine if the COVID-19 vaccine can be administered to a patient. The DHA Form 207 is used to determine and document patient eligibility and vaccine declinations for a COVID-19 vaccination. Respondents include Active Duty military members, Federal employees, beneficiaries, and contractors (based on their employment) who wish to receive the vaccine.
*Affected Public:* Individuals or households.
*Annual Burden Hours:* 1,500,000.
*Number of Respondents* : 9,000,000.
*Responses per Respondent* : 1.
*Annual Responses:* 9,000,000.
*Average Burden per Response* : 10 minutes.
*Frequency:* On occasion.
Dated: April 13, 2021.
Aaron T. Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.