Information Collection

Request To Employer For Verification Of Applicant's Employment And Earnings

IC 146869 under ICR 198312-2900-017 · OMB 2900-0071.

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Information Collection (IC) Details

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IC Title:	REQUEST TO EMPLOYER FOR VERIFICATION OF APPLICANT'S EMPLOYMENT AND EARNINGS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FL 26-253				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	45,000	13,000	32,000
Annual IC Time Burden (Hours)	7,500	2,167	5,333
Annual IC Cost Burden (Dollars)	0	0	0

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