Information Collection

Employment Navigator Intake Form

IC 245214 under ICR 202101-1293-001 · OMB 1293-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Employment Navigator Intake Form	Form and Instructi
1 Employment Navigator Intake Form Employment Navigator Intake Form.xlsx	Form and Instruction
1 Employment Navigator Intake Form Employment Navigator Intake Form.xlsx	Form and Instruction

IC Title:

Employment Navigator Intake Form

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

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	1	Employment Navigator Intake Form	Employment Navigator Intake Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15,000	15,000
Annual IC Time Burden (Hours)	5,000	5,000
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.