ELIGIBILITY DATA FORM

ICR 197912-1210-002

OMB: 1210-0010

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
121435 Migrated
ICR Details
1210-0010 197912-1210-002
Historical Active 197901-1210-002
DOL/EBSA
ELIGIBILITY DATA FORM
Extension without change of a currently approved collection   No
Regular
Approved without change 01/02/1980
Retrieve Notice of Action (NOA) 12/10/1979
  Inventory as of this Action Requested Previously Approved
12/31/1984 12/31/1984 01/31/1980
3,500 0 3,500
875 0 875
0 0 0

USED IN THE ADMINISTRATION OF CHAPTER 43 OF TITLE 38, U.S. CODE. 1) PROVIDES A UNIFORM METHOD OF OBTAINING ELIGIBILITY DATA AND STATEMENTS OF CLAIMS FROM PERSONS CLAIMING REEMPLOYMENT RIGHTS UNDER THE VETERANS' REEMPLOYMENT RIGHTS STATUTE, AND 2) PROVIDES A SIMPLE METHOD FOR VETERANS AND OTHER CLAIMING REEMPLOYMENT RIGHTS TO ADVISE THE OFFICE OF VETERANS' REEMPLOYMENT RIGHTS OF THEIR DESIRE FOR ASSISTANCE IN EXERCISING THEIR VETERANS' REEMPLOYMENT RIGHTS

None
None


No

1
IC Title Form No. Form Name
ELIGIBILITY DATA FORM LMSA 1010

  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 3,500 3,500 0 0 0 0
Annual Time Burden (Hours) 875 875 0 0 0 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.
12/10/1979


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