Information Collection

Applicant Background Survey

IC 11577 under ICR 201204-1091-001 · OMB 1091-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DI 1935 Applicant Background Survey	Form and Instruction
DI 1935 Applicant Background Survey DI-1935-Applicant-Background-Survey-form 7-31-12.pdf www.doi.gov/pmb/eeo/upload/DI-1935-Applicant-Background-Survey-form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DI 1935	Applicant Background Survey	DI-1935-Applicant-Background-Survey-form 7-31-12.pdf	http://www.doi.gov/pmb/eeo/upload/DI-1935-Applicant-Background-Survey-form.pdf	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: Interior Personnel Records, DOI--79

FR Citation: 64 FR 20010

Number of Respondents: 366,680

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	366,680	30,860	335,820
Annual IC Time Burden (Hours)	6,111	-5,083	11,194
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.