HIRE Vets Medallion Program

Honoring Investments in Recruiting and Employing American Veterans Medallion Program

OMB: 1293-0015

IC ID: 227842

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1293-0015 can be found here:

Documents and Forms

Document Name Document Type
Form VETS-1011LG HIRE Vets Medallion Program Form and Instruction
Account Creation Page - Electronic - 20180126.pdf Other-Account Creation Page
VETS-1011LG 2018 HIRE VETS Application Large Employer Gold (Screensh HIRE Vets - LG - Electronic - Full.pdf Form and Instruction
VETS-1011LG HIRE Vets Medallion Award Application Large Employer Gol HIRE Vets - LG - Paper - Full.pdf Form and Instruction
VETS-1011LP 2018 HIRE VETS Application Large Employer Platinum (Scre HIRE Vets - LP - Electronic - Full.pdf Form and Instruction
VETS-1011LP HIRE Vets Medallion Award Application Large Employer Pla HIRE Vets - LP - Paper - Full.pdf Form and Instruction
VETS-1011MG 2018 HIRE VETS Application Medium Employer Gold (Screens HIRE Vets - MG - Electronic - Full.pdf Form and Instruction
VETS-1011MG HIRE Vets Medallion Award Application Medium Employer Go HIRE Vets - MG - Paper - Full.pdf Form and Instruction
VETS-1011MP 2018 HIRE VETS Application Medium Employer Platinum Gold HIRE Vets - MP - Electronic - Full.pdf Form and Instruction
VETS-1011MP HIRE Vets Medallion Award Application Medium Employer Pl HIRE Vets - MP - Paper - Full.pdf Form and Instruction
VETS-1011SG 2018 HIRE VETS Application Small Employer Gold (Screensh HIRE Vets - SG - Electronic - Full.pdf Form and Instruction
VETS-1011SG HIRE Vets Medallion Award Application Small Employer, Go HIRE Vets - SG - Paper - Full.pdf Form and Instruction
VETS-1011SP 2018 HIRE VETS Application Small Employer Platinum (Scre HIRE Vets - SP - Electronic - Full.pdf Form and Instruction
VETS-1011SP HIRE Vets Medallion Award Application Small Employer - P HIRE Vets - SP - Paper - Full.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HIRE Vets Medallion Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR part 2011, subpart B (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VETS-1011LG	HIRE Vets Medallion Award Application Large Employer Gold	HIRE Vets - LG - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	HIRE Vets Medallion Award Application Large Employer Platinum	HIRE Vets - LP - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	2018 HIRE VETS Application Medium Employer Platinum Gold (Screenshots)	HIRE Vets - MP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Other-Account Creation Page			Account Creation Page - Electronic - 20180126.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	HIRE Vets Medallion Award Application Small Employer, Gold	HIRE Vets - SG - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MP	HIRE Vets Medallion Award Application Medium Employer Platinum	HIRE Vets - MP - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	2018 HIRE VETS Application Small Employer Platinum (Screenshots)	HIRE Vets - SP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SP	HIRE Vets Medallion Award Application Small Employer - Platinum	HIRE Vets - SP - Paper - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LP	2018 HIRE VETS Application Large Employer Platinum (Screenshots)	HIRE Vets - LP - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MG	2018 HIRE VETS Application Medium Employer Gold (Screenshots)	HIRE Vets - MG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011SG	2018 HIRE VETS Application Small Employer Gold (Screenshots)	HIRE Vets - SG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011LG	2018 HIRE VETS Application Large Employer Gold (Screenshots)	HIRE Vets - LG - Electronic - Full.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VETS-1011MG	HIRE Vets Medallion Award Application Medium Employer Gold	HIRE Vets - MG - Paper - Full.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,136	Number of Respondents for Small Entity: 1,011

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

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	34,711	34,711
Annual IC Time Burden (Hours)	59,571	59,571
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.