SUPPLEMENTAL REPORT OF SERVICE OR COMPENSATION (BY EMPLOYER FOR PERIODS SUBSEQUENT TO THOSE ALREADY FILED)

ICR 197904-3220-005

OMB: 3220-0070

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
3220-0070 197904-3220-005
Historical Active 197903-3220-007
RRB
SUPPLEMENTAL REPORT OF SERVICE OR COMPENSATION (BY EMPLOYER FOR PERIODS SUBSEQUENT TO THOSE ALREADY FILED)
Extension without change of a currently approved collection   No
Regular
Approved without change 05/29/1979
Retrieve Notice of Action (NOA) 04/27/1979
  Inventory as of this Action Requested Previously Approved
06/30/1980 06/30/1980 05/31/1979
5,000 0 5,000
833 0 833
0 0 0



None
None


No

1
IC Title Form No. Form Name
SUPPLEMENTAL REPORT OF SERVICE OR COMPENSATION (BY EMPLOYER FOR PERIODS SUBSEQUENT TO THOSE ALREADY FILED) UI-41

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 833 833 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/27/1979


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