Information Collection

Application for Employment as a Locally Employed Staff or Family Member

IC 190750 under ICR 202512-1405-001 · OMB 1405-0189.

Documents and Forms

Document Name Document Type
Form DS-174 Application for Employment as a Locally Employed Staff or Family Member Application for Employment as a Locally Employed Staff or Family Member Form and Instruction
Screenshots 2019.docx Other-Screenshots
DS-174 Application for Employment as a Locally Employed Staff o DS-0174.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Employment as a Locally Employed Staff or Family Member	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Form and Instruction	DS-174	Application for Employment as a Locally Employed Staff or Family Member	DS-0174.pdf		Yes	Yes	Fillable Fileable
Other-Screenshots			Screenshots 2019.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,000,000	1,000,000
Annual IC Time Burden (Hours)	-750,000	750,000
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.

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