Information Collection

Employer Service and Compensation Reports

IC 33875 under ICR 201608-3220-002 · OMB 3220-0070.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0070 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form UI-41 (06-16) Employer Service and Compensation Reports	Form
UI-41 (06-16) Supplemental Report of Service and Compensation Form UI-41 (06-16).pdf	Form
UI-41a (06-16) Supplemental Report of Compensation Form UI-41A (06-16).pdf	Form
Form UI-23 (08-16).pdf UI-23, Statement of Service for Railroad Unemployment Insurance Benefits	IC Document
BA-3 (Internet) (01-12).pdf BA-3 (01-12)	IC Document

IC Title:

Employer Service and Compensation Reports

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 302

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	UI-41 (06-16)	Supplemental Report of Service and Compensation	Form UI-41 (06-16).pdf		No		Printable Only
Form	UI-41a (06-16)	Supplemental Report of Compensation	Form UI-41A (06-16).pdf		No		Printable Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title: RRB-21, Railroad Unemployment and Sickness Insurance Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 30

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	-300	450
Annual IC Time Burden (Hours)	20	-40	60
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
UI-23, Statement of Service for Railroad Unemployment Insurance Benefits	Form UI-23 (08-16).pdf	08/31/2016
BA-3 (01-12)	BA-3 (Internet) (01-12).pdf	08/31/2016

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