Information Collection

Application For County Employment And Supplemental Qualifications Statement

IC 100033 under ICR 198901-0560-001 · OMB 0560-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0560-0016 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	APPLICATION FOR COUNTY EMPLOYMENT AND SUPPLEMENTAL QUALIFICATIONS STATEMENT	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	ASCS-650				No	No
Form	ASCS-675				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,000	1,000	14,000
Annual IC Time Burden (Hours)	16,000	2,000	14,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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