Information Collection

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

IC 14753 under ICR 201906-1293-003 · OMB 1293-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0002 can be found here:

Documents and Forms

Document Name Document Type
VP_and_USERRA_Claim_Instructions_20131018.docx Instruction
e1010 2 Sec I Screen.jpg Other-Online Screen 2
e1010 3 Sec II Screen.jpg Other-Online Screen 3
e1010 4 Sec III Screen.jpg Other-Online Screen 4
e1010 5 Sec IV USERRA Screen.jpg Other-Online Screen 5
e1010 6 Sec IV VP Screen.jpg Other-Online Screen 6
e1010 7 Comments Screen.jpg Other-Online Screen 7
e1010 8 Signature Screen.jpg Other-Online Screen 8
VETS-1010 VETS/USERRA/VP Form 1010 vets-1010-Form-161102(OCIO_Edits_20161201)Upload (1).docx vets1010.dol.gov Form
VETS-1010 USERRA/VP Electronic Complaint Form e1010 1 Login Screen.jpg vets1010.dol.gov/ Form and Instruction

Information Collection (IC) Details

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
Instruction			VP_and_USERRA_Claim_Instructions_20131018.docx		Yes	Yes	Printable Only
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
Form	VETS-1010	VETS/USERRA/VP Form 1010	vets-1010-Form-161102(OCIO_Edits_20161201)Upload (1).docx	https://vets1010.dol.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	VETS-1010	USERRA/VP Electronic Complaint Form	e1010 1 Login Screen.jpg	https://vets1010.dol.gov/	Yes	Yes	Fillable Fileable Signable

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: 80 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,250	2,250
Annual IC Time Burden (Hours)	1,125	1,125
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.