Information Collection

Service Termination Information

IC 203963 under ICR 201408-1205-005 · OMB 1205-0505.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0505 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B-3 Participant Service Termination Form-SET-revised 01 02 2013.docx	Other-Participant Service Terminatio

IC Title:

Service Termination Information

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Participant Service Termination Form			Appendix B-3 Participant Service Termination Form-SET-revised 01 02 2013.docx		Yes	Yes	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	30	30
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.