Information Collection

Employment Questionnaire

IC 42185 under ICR 200210-2900-013 · OMB 2900-0079.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Employment Questionnaire	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:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21-4140	No	No
Form	21-4140A	No	No
Form	21-4140-1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,480	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	45,480	45,480
Annual IC Time Burden (Hours)	3,790	3,790
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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