Information Collection

Request for Employment Information

IC 13773 under ICR 200611-1215-003 · OMB 1215-0105.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0105 can be found here:

Documents and Forms

Document Name Document Type
ca-1027.doc Other-Letter

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Employment Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Letter			ca-1027.doc		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 58 FR 49556

Number of Respondents: 500	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	500	0	500
Annual IC Time Burden (Hours)	125	0	125
Annual IC Cost Burden (Dollars)	210	210	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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