Information Collection

Application for Employment as a Locally Employed Staff or Family Member

IC 190750 under ICR 201710-1405-003 · OMB 1405-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0189 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-174 Application for Employment as a Locally Employed Staff or Family Member	Form and Instruction
DS-174 Application for Employment as a Locally Employed Staff o ds174 - DRAFT - 11-07-2017.pdf	Form and Instruction

IC Title:

Application for Employment as a Locally Employed Staff or Family Member

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
Form and Instruction	DS-174	Application for Employment as a Locally Employed Staff or Family Member	ds174 - DRAFT - 11-07-2017.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	40,000	40,000
Annual IC Cost Burden (Dollars)	12,500	12,500

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.