Information Collection

Employer's Deemed Service Month Questionnaire

IC 157784 under ICR 199004-3220-002 · OMB 3220-0156.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0156 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	EMPLOYER'S DEEMED SERVICE MONTH QUESTIONNAIRE	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	GL-99				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 450	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,500	1,500	8,000
Annual IC Time Burden (Hours)	475	75	400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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