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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.