Information Collection

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

IC 14753 under ICR 201607-1293-001 · OMB 1293-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VP_and_USERRA_Claim_Instructions_20131018.docx	Instruction
e1010 1 Login Screen.jpg	Other-Online Screen 1
e1010 2 Sec I Screen.jpg	Other-Online Screen 2
e1010 3 Sec II Screen.jpg	Other-Online Screen 3
e1010 4 Sec III Screen.jpg	Other-Online Screen 4
e1010 5 Sec IV USERRA Screen.jpg	Other-Online Screen 5
e1010 6 Sec IV VP Screen.jpg	Other-Online Screen 6
e1010 7 Comments Screen.jpg	Other-Online Screen 7
e1010 8 Signature Screen.jpg	Other-Online Screen 8
VETS-1010 VETS/USERRA/VP Form 1010 vets-1010-Form-161102(OCIO_Edits_20161201)Upload (1).docx vets1010.dol.gov	Form

IC Title:

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Online Screen 1			e1010 1 Login Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 2			e1010 2 Sec I Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 3			e1010 3 Sec II Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 4			e1010 4 Sec III Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 5			e1010 5 Sec IV USERRA Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 6			e1010 6 Sec IV VP Screen.jpg		Yes	Yes	Fillable Fileable Signable
Other-Online Screen 7			e1010 7 Comments Screen.jpg		Yes	Yes	Fillable Fileable Signable
Instruction			VP_and_USERRA_Claim_Instructions_20131018.docx		Yes	Yes	Printable Only
Other-Online Screen 8			e1010 8 Signature Screen.jpg		Yes	Yes	Fillable Fileable Signable
Form	VETS-1010	VETS/USERRA/VP Form 1010	vets-1010-Form-161102(OCIO_Edits_20161201)Upload (1).docx	https://vets1010.dol.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/VETS-1 and DOL/VETS-2

FR Citation: 67 FR 16816

Number of Respondents: 2,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	1,125	1,125
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.