Information Collection

Investigation of Claim for Possible Days of Employment or State Benefits Received

IC 33862 under ICR 199706-3220-004 · OMB 3220-0049.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Investigation of Claim for Possible Days of Employment or State Benefits Received

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	ID-5I	No	No
Form	UI-48	No	No
Form	ID-5R(SUP)	No	No
Form	ID-49R	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,900

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,900	94,553	-99,253	10,600
Annual IC Time Burden (Hours)	1,388	342	-359	1,405
Annual IC Cost Burden (Dollars)	0	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.