Information Collection

Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference Eligibility

IC 14753 under ICR 202512-1293-001 · OMB 1293-0002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1010 USERRA/VP/VEOA Claim Form Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference Eligibility	Form
Form 1010 USERRA/VP/VEOA Claim Form (electronic) Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference Eligibility	Form
VETS-Form-1010a.pdf www.dol.gov/agencies/vets/programs/userra/vets1010	Instruction
1010 USERRA/VP/VEOA Claim Form VETS-Form-1010.pdf www.dol.gov/agencies/vets/programs/userra/vets1010	Form
1010 USERRA/VP/VEOA Claim Form (electronic) VETS-e1010-VCMS (1).pdf www.dol.gov/agencies/vets/programs/userra/vets1010	Form

IC Title:

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1010	https://www.dol.gov/agencies/vets/programs/userra/vets1010	Yes	Yes	Fillable Fileable Signable
Instruction		https://www.dol.gov/agencies/vets/programs/userra/vets1010	Yes	No	Printable Only
Form	1010	https://www.dol.gov/agencies/vets/programs/userra/vets1010	Yes	Yes	Fillable Fileable Signable

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: 80 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,250	0	2,250
Annual IC Time Burden (Hours)	1,688	0	1,688
Annual IC Cost Burden (Dollars)	99	99	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.

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