EMPLOYMENT QUESTIONNAIRE

ICR 197704-2900-001

OMB: 2900-0079

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
146921 Migrated
ICR Details
2900-0079 197704-2900-001
Historical Active
VA
EMPLOYMENT QUESTIONNAIRE
Revision of a currently approved collection   No
Regular
Approved without change 05/17/1977
Retrieve Notice of Action (NOA) 04/11/1977
  Inventory as of this Action Requested Previously Approved
04/30/1982 04/30/1982
43,000 0 0
3,583 0 0
0 0 0

THIS FORM IS USED AS A CONTROL FOR TOTAL COMPENSATION EVALUATIONS BASED ON INDIVIDUAL UNEMPLOYABILITY. THE INFORMATION FURNISHED BY THE VETERAN IS REVIEWED ANNUALLY FOR A MAXIMUM OF 10 YEARS OR UNTIL AGE 60 TO DETERMINE CONTINUED ENTITLEMENT TO THE TOTAL COMPENSATION EVALUATION.

None
None


No

1
IC Title Form No. Form Name
EMPLOYMENT QUESTIONNAIRE 21-4140

  Total Approved 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 43,000 0 0 0 43,000 0
Annual Time Burden (Hours) 3,583 0 0 0 3,583 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/11/1977


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