Information Collection

HIRE Vets Medallion Program

IC 227842 under ICR 201710-1293-002 · OMB 1293-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VETS-1011LG HIRE Vets Medallion Program	Form and Instruction
Account Creation.pdf	Other-Account Creation Page
VETS-1011LG 2018 HIRE VETS Application Large Employer Gold (Screensh HIRE Vets - LG - Electronic - Full.pdf	Form and Instruction
VETS-1011LG HIRE Vets Medallion Award Application Large Employer Gol HIRE Vets - LG - Paper - Full.pdf	Form and Instruction
VETS-1011LP 2018 HIRE VETS Application Large Employer Platinum (Scre HIRE Vets - LP - Electronic - Full.pdf	Form and Instruction
VETS-1011LP HIRE Vets Medallion Award Application Large Employer Pla HIRE Vets - LP - Paper - Full.pdf	Form and Instruction
VETS-1011MG 2018 HIRE VETS Application Medium Employer Gold (Screens HIRE Vets - MG - Electronic - Full.pdf	Form and Instruction
VETS-1011MG HIRE Vets Medallion Award Application Medium Employer Go HIRE Vets - MG - Paper - Full.pdf	Form and Instruction
VETS-1011MP 2018 HIRE VETS Application Medium Employer Platinum Gold HIRE Vets - MP - Electronic - Full.pdf	Form and Instruction
VETS-1011MP HIRE Vets Medallion Award Application Medium Employer Pl HIRE Vets - MP - Paper - Full.pdf	Form and Instruction
VETS-1011SG 2018 HIRE VETS Application Small Employer Gold (Screensh HIRE Vets - SG - Electronic - Full.pdf	Form and Instruction
VETS-1011SG HIRE Vets Medallion Award Application Small Employer, Go HIRE Vets - SG - Paper - Full.pdf	Form and Instruction
VETS-1011SP 2018 HIRE VETS Application Small Employer Platinum (Scre HIRE Vets - SP - Electronic - Full.pdf	Form and Instruction
VETS-1011SP HIRE Vets Medallion Award Application Small Employer - P HIRE Vets - SP - Paper - Full.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

HIRE Vets Medallion Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR part 2011, subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VETS-1011LG	2018 HIRE VETS Application Large Employer Gold (Screenshots)	HIRE Vets - LG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	2018 HIRE VETS Application Large Employer Platinum (Screenshots)	HIRE Vets - LP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	HIRE Vets Medallion Award Application Large Employer Platinum	HIRE Vets - LP - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MG	2018 HIRE VETS Application Medium Employer Gold (Screenshots)	HIRE Vets - MG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MG	HIRE Vets Medallion Award Application Medium Employer Gold	HIRE Vets - MG - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Other-Account Creation Page			Account Creation.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LG	HIRE Vets Medallion Award Application Large Employer Gold	HIRE Vets - LG - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	2018 HIRE VETS Application Medium Employer Platinum Gold (Screenshots)	HIRE Vets - MP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	HIRE Vets Medallion Award Application Medium Employer Platinum	HIRE Vets - MP - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	2018 HIRE VETS Application Small Employer Gold (Screenshots)	HIRE Vets - SG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	HIRE Vets Medallion Award Application Small Employer, Gold	HIRE Vets - SG - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	2018 HIRE VETS Application Small Employer Platinum (Screenshots)	HIRE Vets - SP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	HIRE Vets Medallion Award Application Small Employer - Platinum	HIRE Vets - SP - Paper - Full.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,136

Number of Respondents for Small Entity: 1,011

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	34,711	34,711
Annual IC Time Burden (Hours)	59,571	59,571
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.