Application for Employment as a Locally Employed Staff or Family Member

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0189 can be found here:

Documents and Forms

Document Name Document Type
Form DS-174 Application for Employment as a Locally Employed Staff or Family Member Form and Instruction
DS-174 Application for Employment as a Locally Employed Staff o ds0174_FINAL_DEC_2012.pdf Form and Instruction
DS-174ar Application for Employment as a Locally Employed Staff o DS-174ar Arabic (6-2014).pdf Form and Instruction
DS-174fr Application for Employment as a Locally Employed Staff o DS-174fr French (6-2014).pdf Form and Instruction
DS-174sp Application for Employment as a Locally Employed Staff o DS-174sp Spanish (6-2014).pdf Form and Instruction
DS-175 Translations Certification (6-2014).pdf Translation Certification (6-2014) IC Document

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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-174	Application for Employment as a Locally Employed Staff or Family Member	ds0174_FINAL_DEC_2012.pdf	Yes	Yes	Fillable Printable
Form and Instruction	DS-174ar	Application for Employment as a Locally Employed Staff or Family Member - Arabic	DS-174ar Arabic (6-2014).pdf	Yes	No	Printable Only
Form and Instruction	DS-174fr	Application for Employment as a Locally Employed Staff or Family Member - French	DS-174fr French (6-2014).pdf	Yes	No	Printable Only
Form and Instruction	DS-174sp	Application for Employment as a Locally Employed Staff or Family Member - Spanish	DS-174sp Spanish (6-2014).pdf	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Previously Approved
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	40,000	40,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Translation Certification (6-2014)	DS-175 Translations Certification (6-2014).pdf	06/23/2014

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