Information Collection

Wage Statement (english And Spanish)

IC 122285 under ICR 199404-1215-003 · OMB 1215-0148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

WAGE STATEMENT (ENGLISH AND SPANISH)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	WH-501R				No	No
Form	WH-501R(S)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,500,000	1,448,000	52,000
Annual IC Time Burden (Hours)	325,000	264,334	60,666
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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