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⚠️ Notice: This information collection may be referencing outdated material.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) Supplemental Report of Service and Compensation Employer Service and Compensation Reports	Form
Form UI-41a (06-16) Supplemental Report of Compensation 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)				No		Printable Only
Form	UI-41a (06-16)				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		08/31/2016
BA-3 (01-12)		08/31/2016

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].