Information Collection

Sick Pay and Miscellaneous Payments Report

IC 33977 under ICR 199808-3220-003 · OMB 3220-0175.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0175 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Sick Pay and Miscellaneous Payments Report	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	BA-10				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 172	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 65 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	172	32	140
Annual IC Time Burden (Hours)	158	30	128
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.