Information Collection

HIRE Vets Medallion Program

IC 227842 under ICR 201811-1293-002 · OMB 1293-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0015 can be found here:

Documents and Forms

Document Name Document Type
HIRE-Vets-Account-Registration.pdf Other-Account Registration Page
VETS-1011LG HIRE Vets Application Large Employer Gold (Paper) HIRE Vets Application Large Employer Gold (Paper) VETS-1011LG.pdf Form and Instruction
VETS-1011LG HIRE Vets Application Large Employer Gold (Screenshot) HIRE Vets Application Large Employer Gold (Screenshot) VETS-1011LG.pdf Form and Instruction
VETS-1011LP HIRE Vets Application Large Employer Platinum (Paper) HIRE Vets Application Large Employer Platinum (Paper) VETS-1011LP.pdf Form and Instruction
VETS-1011LP HIRE Vets Application Large Employer Platinum (Screensho HIRE Vets Application Large Employer Platinum (Screenshot) VETS-1011LP.pdf Form and Instruction
VETS-1011MP HIRE Vets Application Medium Employer Gold (Paper) HIRE Vets Application Medium Employer Gold (Paper) VETS-1011MG.pdf Form and Instruction
VETS-1011MG HIRE Vets Application Medium Employer Gold (Screenshot) HIRE Vets Application Medium Employer Gold (Screenshot) VETS-1011MG.pdf Form and Instruction
VETS-1011MP HIRE Vets Application Medium Employer Platinum (Paper) HIRE Vets Application Medium Employer Platinum (Paper) VETS-1011MP.pdf Form and Instruction
VETS-1011MP HIRE Vets Application Medium Employer Platinum (Screensh HIRE Vets Application Medium Employer Platinum (Screenshot) VETS-1011MP.pdf Form and Instruction
VETS-1011SG HIRE Vets Application Small Employer Gold (Paper) HIRE Vets Application Small Employer Gold (Paper) VETS-1011SG.pdf Form and Instruction
VETS-1011SG HIRE Vets Application Small Employer Gold (Screenshot) HIRE Vets Application Small Employer Gold (Screenshot) VETS-1011SG.pdf Form and Instruction
VETS-1011SP HIRE Vets Application Small Employer Platinum (Paper) HIRE Vets Application Small Employer Platinum (Paper) VETS-1011SP.pdf Form and Instruction
VETS-1011SP HIRE Vets Application Small Employer Platinum (Screensho HIRE Vets Application Small Employer Platinum (Screenshot) VETS-1011SP.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIRE Vets Medallion Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR part 2011, subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Account Registration Page			HIRE-Vets-Account-Registration.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LG	HIRE Vets Application Large Employer Gold (Paper)	HIRE Vets Application Large Employer Gold (Paper) VETS-1011LG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LG	HIRE Vets Application Large Employer Gold (Screenshot)	HIRE Vets Application Large Employer Gold (Screenshot) VETS-1011LG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	HIRE Vets Application Large Employer Platinum (Paper)	HIRE Vets Application Large Employer Platinum (Paper) VETS-1011LP.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	HIRE Vets Application Large Employer Platinum (Screenshot)	HIRE Vets Application Large Employer Platinum (Screenshot) VETS-1011LP.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MG	HIRE Vets Application Medium Employer Gold (Screenshot)	HIRE Vets Application Medium Employer Gold (Screenshot) VETS-1011MG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	HIRE Vets Application Medium Employer Gold (Paper)	HIRE Vets Application Medium Employer Gold (Paper) VETS-1011MG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	HIRE Vets Application Medium Employer Platinum (Paper)	HIRE Vets Application Medium Employer Platinum (Paper) VETS-1011MP.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	HIRE Vets Application Medium Employer Platinum (Screenshot)	HIRE Vets Application Medium Employer Platinum (Screenshot) VETS-1011MP.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	HIRE Vets Application Small Employer Gold (Paper)	HIRE Vets Application Small Employer Gold (Paper) VETS-1011SG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	HIRE Vets Application Small Employer Gold (Screenshot)	HIRE Vets Application Small Employer Gold (Screenshot) VETS-1011SG.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	HIRE Vets Application Small Employer Platinum (Paper)	HIRE Vets Application Small Employer Platinum (Paper) VETS-1011SP.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	HIRE Vets Application Small Employer Platinum (Screenshot)	HIRE Vets Application Small Employer Platinum (Screenshot) VETS-1011SP.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,136	Number of Respondents for Small Entity: 1,011

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

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	34,711	34,711
Annual IC Time Burden (Hours)	59,571	59,571
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.