Information Collection

Certified List

IC 253172 under ICR 202204-1235-003 · OMB 1235-0033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1235-0033 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Certified List	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 9.12 29 CFR 4.6

Information Collection Instruments:

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

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43,000	Number of Respondents for Small Entity: 30

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	645,000	645,000
Annual IC Time Burden (Hours)	10,750	10,750
Annual IC Cost Burden (Dollars)	0	0

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