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Agenda
Reg Review
ICR
View Information Collection (IC)
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-1010
VETS/USERRA/VP Form 1010
vets-1010-Form-130724.docx
Yes
Yes
Fillable Fileable Signable
Instruction
VP_and_USERRA_Claim_Instructions_20131018.docx
Yes
Yes
Printable Only
Other-Online Screen 1
e1010 1 Login Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 2
e1010 2 Sec I Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 3
e1010 3 Sec II Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 4
e1010 4 Sec III Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 5
e1010 5 Sec IV USERRA Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 6
e1010 6 Sec IV VP Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 7
e1010 7 Comments Screen.jpg
Yes
Yes
Fillable Fileable Signable
Other-Online Screen 8
e1010 8 Signature Screen.jpg
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
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:
73 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,250
0
-250
0
0
2,500
Annual IC Time Burden (Hours)
1,125
0
-125
0
0
1,250
Annual IC Cost Burden (Dollars)
0
0
0
0
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.