Information Collection

Investigation of Claim for Possible Days of Employment

IC 34016 under ICR 201010-3220-004 · OMB 3220-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ID-5S(SUP) (10-07) Investigation of Claim for Possible Days of Employment	Form
ID-5S(SUP) (10-07) Report of Case for Which All Days were Claimed During a Form ID-5S (SUP) (10-07).pdf	Form
ID-5S (10-07) ID-5S(SUP) Transmittal Letter Form ID-5S (10-07).pdf	Form and Instruction

IC Title:

Investigation of Claim for Possible Days of Employment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 322.4(b)

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	ID-5S(SUP) (10-07)	Report of Case for Which All Days were Claimed During a Month Credited Per an Adjustment Report	Form ID-5S (SUP) (10-07).pdf		No		Paper Only
Form and Instruction	ID-5S (10-07)	ID-5S(SUP) Transmittal Letter	Form ID-5S (10-07).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title: RRB 6 - Unemployment Insurance Record File

FR Citation: 75 FR 43716

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.