Multistate Employer Notification Form

National Directory of New Hires

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
MSE FORM final 01-18-07.doc Other-MSEN Form

Information Collection (IC) Details

IC Title:	Multistate Employer Notification Form	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-MSEN Form			MSE FORM final 01-18-07.doc		No	No	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,632	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,632	1,824	2,808
Annual IC Time Burden (Hours)	232	23	209
Annual IC Cost Burden (Dollars)	0	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.