Form W-11 - Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit

Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2173 can be found here:

Documents and Forms

Document Name Document Type
Form W-11 Form W-11 - Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit Form and Instruction
W-11 Hiring Incentives to Restore Employment (HIRE) Act Emplo 10fW-11.PRAN markup.pdf Form and Instruction
brdn_busi.pdf 2010 burden estimate IC Document

Information Collection (IC) Details

IC Title:	Form W-11 - Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	W-11	Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit	10fW-11.PRAN markup.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	227,000	227,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2010 burden estimate	brdn_busi.pdf	04/27/2010

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