Information Collection

Employment Certification Form

IC 235408 under ICR 202105-2900-002 · OMB 2900-0874.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0874 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 22-10201 Employment Certification Form	Form
VA Form 22-10201 Employment Certification Form 22-10201(5-5-21).pdf www.va.gov/vaforms	Form
VA Form 22-10201 Employment Certification Form 22-10201(5-5-21).pdf www.va.gov/vaforms	Form

IC Title:

Employment Certification Form

Agency IC Tracking Number:

2900-0874

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	VA Form 22-10201	Employment Certification Form	22-10201(5-5-21).pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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	Previously Approved
Annual Number of Responses for this IC	562,500	562,500
Annual IC Time Burden (Hours)	46,875	46,875
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.