Information Collection

Employment Verification Form

IC 190908 under ICR 201604-1810-001 · OMB 1810-0698.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1810-0698 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Employment Verification Form	Form and Instruction
Employment Verification Form 1810-0698 2016 PD Employee Verification Form.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Employment Verification Form

Agency IC Tracking Number:

ED-2016-ICCD-0012

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 263

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	N/A	Employment Verification Form	1810-0698 2016 PD Employee Verification Form.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: Indian Education Individual Reporting on Regulatory Compliance Related to the Indian Education Professional Development programs Service Obligation and GPRA

FR Citation: 76 FR 4334

Number of Respondents: 847

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	847	-173	1,020
Annual IC Time Burden (Hours)	280	-740	1,020
Annual IC Cost Burden (Dollars)	0	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.