Information Collection

Employment Specialists

IC 220576 under ICR 201603-0930-004 · OMB 0930-0363.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ENFG Employment Sp Employment Specialists	Form and Instruction
ENFG Employment Sp ENFG Employment Specialist Version Attachment O_ENFG Employment Specialist Version.docx	Form and Instruction
Attachment S_ENFG Employment Specialist Informed Consent.docx ENFG Employment Specialist Informed Consent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	ENFG Employment Specialist Version	ENFG Employment Specialist Version	Attachment O_ENFG Employment Specialist Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ENFG Employment Specialist Informed Consent	Attachment S_ENFG Employment Specialist Informed Consent.docx	03/10/2016

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