Information Collection

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

IC 14753 under ICR 202502-1293-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form VETS Form 1010 Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference Form
Form VETS Form 1010 USERRA/VP/VEOA Claim Form Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference Form
ICR 1293-0002 Update Form VETS E1010a - EO14168 20250203.pdf www.dol.gov/agencies/vets/programs/userra/fileaclaim Instruction
VETS-Form-1010a-20250327.pdf www.dol.gov/agencies/vets/programs/userra/fileaclaim Instruction
VETS Form 1010 USERRA/VP/VEOA Claim Form ICR 1293-0002 Update Form VETS E1010 20250205.pdf www.dol.gov/agencies/vets/programs/userra/fileaclaim Form
VETS Form 1010 USERRA/VP/VEOA Claim Form VETS-Form-1010_20250327.pdf www.dol.gov/agencies/vets/programs/userra/fileaclaim Form

Information Collection (IC) Details

View Information Collection (IC)

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:

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	VETS-Form-1010_20250327.pdf	https://www.dol.gov/agencies/vets/programs/userra/fileaclaim	Yes	Yes	Fillable Fileable Signable
Instruction			VETS-Form-1010a-20250327.pdf	https://www.dol.gov/agencies/vets/programs/userra/fileaclaim	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	1,688	1,688
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.

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