Information Collection

Service Termination Information

IC 203963 under ICR 201408-1205-005 · OMB 1205-0505.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0505 can be found here:

Documents and Forms

Document Name Document Type
Appendix B-3 Participant Service Termination Form-SET-revised 01 02 2013.docx Other-Participant Service Terminatio

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Service Termination Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Other-Participant Service Termination Form			Appendix B-3 Participant Service Termination Form-SET-revised 01 02 2013.docx		Yes	Yes	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	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.