Information Collection

Pay Rate Report

IC 33898 under ICR 200708-3220-001 · OMB 3220-0097.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form UI-1e (04-04) Pay Rate Report	Form
UI-1e (04-04) Request for Pay Rate Information Form UI-1e (current).pdf	Form
Form UI-41 (10-00).pdf Form UI-41, Supplemental Report of Service and Compensation	IC Document

IC Title:

Pay Rate Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 330

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	UI-1e (04-04)	Request for Pay Rate Information	Form UI-1e (current).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 Benfit System

FR Citation: 40 FR 36275

Number of Respondents: 350

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	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form UI-41, Supplemental Report of Service and Compensation	Form UI-41 (10-00).pdf	08/15/2007

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