Information Collection

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

IC 14753 under ICR 202302-1293-001 · OMB 1293-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VETS Form 1010 Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference	Form
USERRA-VP-VEOA-FORM-1010a-clearance.pdf	Instruction
USERRA-VP-VEOA-FORM-1010a-clearance.pdf	Instruction
VETS Form 1010 USERRA/VP/VEOA Claim Form USERRA-VP-VEOA-FORM-1010-clearance.pdf	Form
VETS Form 1010 USERRA/VP/VEOA Claim Form USERRA-VP-VEOA-FORM-1010-clearance.pdf	Form

IC Title:

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

Agency IC Tracking Number:

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	VETS Form 1010	USERRA/VP/VEOA Claim Form	USERRA-VP-VEOA-FORM-1010-clearance.pdf		Yes	Yes	Fillable Fileable Signable
Instruction			USERRA-VP-VEOA-FORM-1010a-clearance.pdf		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/VETS-1 and DOL/VETS-2

FR Citation: 67 FR 16816

Number of Respondents: 2,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,250	0	2,250
Annual IC Time Burden (Hours)	1,688	563	1,125
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.