Information Collection

State Bonding Coordinators or AJC Counselors -- Data Collection and Submission

IC 238575 under ICR 202506-1205-004 · OMB 1205-0541.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0541 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fidelity Bonding Issuance Form 061325.docx	Other-Fidelity Bonding Issuance Form
Fidelity Bonding Issuance Form 061325.docx	Other-Fidelity Bonding Issuance Form
Fidelity Bonding Issuance Form tracked.docx Fidelity Bonding Issuance Form tracked	IC Document
Fidelity Bonding Issuance Form tracked.docx Fidelity Bonding Issuance Form tracked	IC Document

IC Title:

State Bonding Coordinators or AJC Counselors -- Data Collection and Submission

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
Other-Fidelity Bonding Issuance Form					Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	800	800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fidelity Bonding Issuance Form tracked		06/13/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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