Tear-off Sheet, Voluntary Disability Disclosure

Registration and Equal Employment Opportunity in Apprenticeship Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0223 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 671 Tear-off Sheet, Voluntary Disability Disclosure Form and Instruction
ETA 671 Voluntary Disability Disclosure ETA Form 671 Tear off Voluntary Disability Disclosure 042721.docx Form and Instruction
ETA 671 Voluntary Disability Disclosure ETA Form 671 Tear off Voluntary Disability Disclosure 042721.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Tear-off Sheet, Voluntary Disability Disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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	ETA 671	Voluntary Disability Disclosure	ETA Form 671 Tear off Voluntary Disability Disclosure 042721.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: 252,271	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	252,271	252,271
Annual IC Time Burden (Hours)	146,317	146,317
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.