Information Collection

Employee Reference Questionnaire

IC 204963 under ICR 201211-1103-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB Number 1103-NE Employee Reference Questionnaire	Form
1103-NEW_DOJ Employment Reference Questionnaire Instructions FINAL_112712.docx	Instruction
OMB Number 1103-NE Employee Reference Questionnaire 1103-NEW_DOJ Employment Reference Questionnaire FINAL_112712.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR Chapter I, A, 5, Section. 5.2 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	OMB Number 1103-NEW	Employee Reference Questionnaire	1103-NEW_DOJ Employment Reference Questionnaire FINAL_112712.docx		Yes	No	Fillable Fileable
Instruction			1103-NEW_DOJ Employment Reference Questionnaire Instructions FINAL_112712.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	3,333	3,333
Annual IC Cost Burden (Dollars)	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.