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Federal agencies are to use a newly created “Certification of Vaccination” form to carry out the Biden administration’s requirement that employees either attest that they are fully vaccinated or be subject to stricter safety protocols.

Exactly when employees will start receiving the forms to fill out—or not—remains uncertain and likely will vary among agencies and also among agency components. The Justice Department for example has told its employees that a link to an electronic version of the form “will be available soon.” The department said it is carrying out the requirement ahead of its workplace “reentry” plan, “which we expect to finalize and share with DoJ employees and contractors in the next few weeks,” a memo said.


The form gives employees four options: “I am fully vaccinated” (meaning at least two weeks after receiving a single-dose vaccine or the second dose of a two-dose vaccine); “I am not yet fully vaccinated” (meaning they are in the process but haven’t yet met that requirement); “I have not been vaccinated”; and “I decline to respond.”

The form says that “Providing this information is voluntary. However, if you fail to provide this information, you will be treated as not fully vaccinated” — meaning subject to stricter policies on mask wearing, physical distancing, travel and quarantine, as well as testing as often as twice a week. That will apply both to those who check “I decline to respond” and those “who choose not to complete the form,” it says.

Employees who say they are not yet fully vaccinated will be treated as unvaccinated for the meantime and are to resubmit the form once they meet the standard for full vaccination.

Those that wish to cite medical or religious reasons for not being vaccinated are to check one of the latter two boxes. They too will be treated as not fully vaccinated but may “use the agency’s established reasonable accommodations process to seek an accommodation, if necessary, related to agency safety protocols or procedures,” according to guidance regarding the form posted by the Safer Federal Workforce Task Force.

The Justice Department memo adds that its employees who are not fully vaccinated “will be required to obtain and provide to their supervisor (or component designee) a negative COVID-19 test result, from a test taken within the past three days, each time they enter a Department facility or participate in an official meeting or function” in person. The department “is developing a program to facilitate testing for employees,” it says.

Declining to reveal one’s vaccination status will not result in disciplinary action but making a false statement could, the form says.

Employees are to attest that “the information provided in this form is accurate and true to the best of my knowledge. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). I understand that making a false statement on this form could result in additional administrative action including an adverse personnel action up to and including removal from my position.”


The guidance from the task force adds that “falsification could also affect continuing eligibility for access to classified information or for employment in a national security position under applicable adjudicative guidelines.” Since eligibility for access to classified information is a condition of employment for many positions, that could effectively require separation, at least from that position.

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2022 Federal Employees Handbook