Employer Short-Form Survey

Demonstration and Evaluation of the Short-Time Compensation Program

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Employer Short-Form Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.