Information Collection

Quarterly Reporting

IC 201795 under ICR 201211-1205-002 · OMB 1205-0492.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Collection of Evaluation Data Elements.doc	Other-evaluation data elements
Demonstration Quarterly Report requirements.doc	Other-quarterly report requirements

IC Title:

Quarterly Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Other-evaluation data elements					Yes	Yes	Fillable Fileable
Other-quarterly report requirements					Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	0	40
Annual IC Time Burden (Hours)	3,200	0	3,200
Annual IC Cost Burden (Dollars)	0	-131,168	131,168

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.

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