Information Collection

Employment Certification Form

IC 235408 under ICR 202209-2900-006 · OMB 2900-0874.

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 VBA-22-10201 (09-13-2022).pdf www.va.gov/vaforms	Form
VA Form 22-10201 Employment Certification Form VBA-22-10201 (09-13-2022).pdf www.va.gov/vaforms	Form

IC Title:

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	VBA-22-10201 (09-13-2022).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: COMPENSATION, PENSION, EDUCATION & VETERAN READINESS AND EMPLOYMENT RECORDS - VA (58/VA21/22/28)

FR Citation: 84 FR 4138

Number of Respondents: 1,908

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	Previously Approved
Annual Number of Responses for this IC	1,908	-560,592	562,500
Annual IC Time Burden (Hours)	159	-46,716	46,875
Annual IC Cost Burden (Dollars)	0	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.