SUPPLEMENTAL EXPERIENCE STATEMENT

ICR 199209-1225-001

OMB: 1225-0010

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
123911 Migrated
ICR Details
1225-0010 199209-1225-001
Historical Active 198911-1225-002
DOL/DM
SUPPLEMENTAL EXPERIENCE STATEMENT
Revision of a currently approved collection   No
Regular
Approved without change 11/24/1992
Retrieve Notice of Action (NOA) 09/28/1992
  Inventory as of this Action Requested Previously Approved
11/30/1995 11/30/1995 11/30/1992
10,350 0 10,350
15,525 0 15,525
0 0 0

THE FORM IS A SUPPLEMENT TO THE BASIC FEDERAL EMPLOYMENT APPLICATION FORM (SF-171) TO ELICIT SPECIFIC JOB-RELATED INFORMATION FROM APPLICANTS TO ASSURE THAT THEIR QUALIFICATIONS ARE ACCURATELY, COMPLETELY, AND EFFICIENTLY EVALUATED.

None
None


No

1
IC Title Form No. Form Name
SUPPLEMENTAL EXPERIENCE STATEMENT DL 1-2034

  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 10,350 10,350 0 0 0 0
Annual Time Burden (Hours) 15,525 15,525 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.
09/28/1992


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