Information Collection

Employers: Employment Verification Record

IC 232924 under ICR 202111-1820-001 · OMB 1820-0617.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1820-0617 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Employers: Employment Verification Record	Form and Instruction
Employment Verification Record RSA PIMS Employment Verification Record ICR Package 1820-0617 (final).docx	Form and Instruction
Employment Verification Record RSA PIMS Employment Verification Record ICR Package 1820-0617 (final).docx	Form and Instruction

IC Title:

Employers: Employment Verification Record

Agency IC Tracking Number:

ED-2018-ICCD-0094

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	NA	Employment Verification Record	RSA PIMS Employment Verification Record ICR Package 1820-0617 (final).docx	PIMS	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: Privacy Act of 1974; System of Records

FR Citation: 84 FR 32889

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	612	612
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.