Information Collection

Employment Specialists

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employment Specialists	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.