Information Collection

Tear-off Sheet, Voluntary Disability Disclosure

IC 200928 under ICR 202404-1205-007 · OMB 1205-0223.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 671 Tear-off Sheet, Voluntary Disability Disclosure	Form and Instruction
Form ETA 671 Voluntary Disability Disclosure Tear-off Sheet, Voluntary Disability Disclosure	Form and Instruction
ETA 671 Voluntary Disability Disclosure ETA Form 671 Tear off Voluntary Disability Disclosure.docx	Form and Instruction
ETA 671 Voluntary Disability Disclosure ETA Form 671 Tear off Voluntary Disability Disclosure.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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	ETA 671	Voluntary Disability Disclosure	ETA Form 671 Tear off Voluntary Disability Disclosure.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 270,759

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	270,759	18,488	252,271
Annual IC Time Burden (Hours)	157,040	10,723	146,317
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.