Information Collection

New Hire States

IC 179587 under ICR 201304-0970-002 · OMB 0970-0166.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0166 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 New Hire States	Form
1 W4 Record layout W4 record layouts_vfinal(3).doc	Form

IC Title:

New Hire States

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
Form	1	W4 Record layout	W4 record layouts_vfinal(3).doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: Location and Collection System

FR Citation: 70 FR 21200

Number of Respondents: 54

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	10,473,138	10,468,638	4,500
Annual IC Time Burden (Hours)	174,556	-125,594	300,150
Annual IC Cost Burden (Dollars)	0	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.