Information Collection

Investigation of Claim for Possible Days of Employment

IC 34016 under ICR 201401-3220-007 · OMB 3220-0196.

Documents and Forms

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

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)				No		Paper Only
Form and Instruction	ID-5S (10-07)				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: 55

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55	-25	80
Annual IC Time Burden (Hours)	9	-4	13
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.

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