Information Collection

Application For Special Industrial Homeworker's Certificate, Application For Authorization To Employ A Student-learner At Subminimum Wages, & Application For Special Workers, Etc.

IC 121780 under ICR 198809-1215-003 · OMB 1215-0005.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0005 can be found here:

Documents and Forms

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Document Name	Document Type

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Information Collection (IC) Details

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IC Title:

APPLICATION FOR SPECIAL INDUSTRIAL HOMEWORKER'S CERTIFICATE, APPLICATION FOR AUTHORIZATION TO EMPLOY A STUDENT-LEARNER AT SUBMINIMUM WAGES, & APPLICATION FOR SPECIAL WORKERS, ETC.

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	WH-2, 205	No	No
Form	222-MIS,	No	No
Form	226-MIS	No	No
Form	227A-MIS	No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	19,200	-4,961	-1,039	25,200
Annual IC Time Burden (Hours)	17,433	-4,333	-907	22,673
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.