Information Collection

Employer Service and Compensation Reports

IC 33875 under ICR 200705-3220-002 · OMB 3220-0070.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0070 can be found here:

Documents and Forms

Document Name Document Type
Form UI-41 (10-00) Employer Service and Compensation Reports Form
UI-41 (10-00) Supplemental Report of Service and Compensation Form UI-41 (10-00).pdf Form
UI-41a (10-01) Supplemental Report of Compensation Form UI-41a (10-01).pdf Form
UI-41 (proposed) Supplemental Report of Service and Compensation Form UI-41(proposed).pdf Form
UI-41a (proposed) Supplemental Report of Compensation Form UI-41a (proposed).pdf Form
Form UI-23 (11-00).pdf UI-23, Statement of Service for Railraod Unemployment Insurance Benefits IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employer Service and Compensation Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 302

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	UI-41 (10-00)	Supplemental Report of Service and Compensation	Form UI-41 (10-00).pdf	No	Paper Only
Form	UI-41a (10-01)	Supplemental Report of Compensation	Form UI-41a (10-01).pdf	No	Paper Only
Form	UI-41 (proposed)	Supplemental Report of Service and Compensation	Form UI-41(proposed).pdf	No	Paper Only
Form	UI-41a (proposed)	Supplemental Report of Compensation	Form UI-41a (proposed).pdf	No	Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title: RRB-21, Railroad Unemployment and Sickness Insurance Benefit System	FR Citation: 40 FR 36275

Number of Respondents: 30	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	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
UI-23, Statement of Service for Railraod Unemployment Insurance Benefits	Form UI-23 (11-00).pdf	06/01/2007

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