Employment Verification Form

Indian Education Professional Development Grants Program: GPRA and Service Payback Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1810-0698 can be found here:

Documents and Forms

Document Name Document Type
Employment Verification Form Form and Instruction
Employment Verification Form IE PD Employment Verifi Form Ins 3.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Employment Verification Form	Agency IC Tracking Number:	04082

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Employment Verification Form	IE PD Employment Verifi Form Ins 3.doc		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,020	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,020	1,020
Annual IC Time Burden (Hours)	1,020	1,020
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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