EEOP Certification form

Equal Employment Opportunity Plan Certification and Short form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0340 can be found here:

Documents and Forms

Document Name Document Type
EEOP Certification form Form
EEOP Certification form EEOP Certification Form 10-17-12.docx Form

Information Collection (IC) Details

IC Title:	EEOP Certification form	Agency IC Tracking Number:	OCR

Is this a Common Form? No		IC Status: New

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	none	EEOP Certification form	EEOP Certification Form 10-17-12.docx	n/a	Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17,865	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	17,865	17,865
Annual IC Time Burden (Hours)	4,466	4,466
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.