Information Collection

Employer Short-Form Survey

IC 215996 under ICR 201504-1291-002 · OMB 1291-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Employer Short-Form Survey	Form and Instruction
1 Iowa Short-Form Employer Survey 201504-1291-002_Iowa Survey SF_2015-10-01_clean_final.docx	Form and Instruction
2 Oregon Short-Form Employer Survey Oregon SF Survey 2-24-2015.docx	Form and Instruction
Invitation letter Iowa 2_25_15-SF.docx Iowa- Invitation letter to participate in web-based short-form survey	IC Document
Invitation letter Iowa 2_25_15-SF_paper.docx Iowa- Invitation letter to participate in paper-based short-form survey	IC Document
Invitation letter Oregon 2_25_15-SF.docx Oregon- Invitation letter to participate in web-based short-form survey	IC Document
Invitation letter Oregon 2_25_15-SF_paper.docx Oregon- Invitation letter to participate in paper-based short-form survey	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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 and Instruction	2	Oregon Short-Form Employer Survey	Oregon SF Survey 2-24-2015.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1	Iowa Short-Form Employer Survey	201504-1291-002_Iowa Survey SF_2015-10-01_clean_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Iowa- Invitation letter to participate in web-based short-form survey	Invitation letter Iowa 2_25_15-SF.docx	04/07/2015
Iowa- Invitation letter to participate in paper-based short-form survey	Invitation letter Iowa 2_25_15-SF_paper.docx	04/07/2015
Oregon- Invitation letter to participate in web-based short-form survey	Invitation letter Oregon 2_25_15-SF.docx	04/07/2015
Oregon- Invitation letter to participate in paper-based short-form survey	Invitation letter Oregon 2_25_15-SF_paper.docx	04/07/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.