Information Collection Request

EMPLOYMENT CERTIFICATION (VA Form 22-10201)

ICR 202209-2900-006 · OMB 2900-0874 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form VA Form 22-10201 Employment Certification Form Form Modified Available
Form VA Form 22-10201 Employment Certification Form Form Modified Repair queued
30-Day FRN - 2900-0874 (2022).pdf Supplementary Document Uploaded 2022-11-23 Repair queued
60-Day FRN.pdf Supplementary Document Uploaded 2022-09-19 Repair queued
SUPPORTING STATEMENT FOR 2022.docx Supporting Statement A Uploaded 2022-09-19 Repair queued
Non Material Non Substatial Revision Request for Revision of VET TEC EMPLOYMENT CERTIFICATION FORM (002) 05052021.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-05-05 Repair queued
Participation Agreement Payment Clause.pdf Supplementary Document Uploaded 2019-12-18 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
235408 Employment Certification Form Form ModifiedEmployment Certification Form
235408 Employment Certification Form Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2026 36 Months From Approved 12/31/2022
1,908 0 562,500
159 0 46,875
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Employment Certification Form VA Form 22-10201

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,908 562,500 0 -560,592 0 0
Annual Time Burden (Hours) 159 46,875 0 -46,716 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No