EEOP short form

Equal Employment Opportunity Plan Certification and Short form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0340 can be found here:

Documents and Forms

Document Name Document Type
EEOP short form Form
EEOP short form EEOP Short Form Screen Shots.pdf Form

Information Collection (IC) Details

IC Title:	EEOP short form	Agency IC Tracking Number:	OCR

Is this a Common Form? No		IC Status: New

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	none	EEOP short form	EEOP Short Form Screen Shots.pdf	n/a	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,286	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,286	3,286
Annual IC Time Burden (Hours)	13,144	13,144
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.