Report of State Employment Service Office

Placement Service

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0057 can be found here:

Documents and Forms

Document Name Document Type
Form ES-21c (07-05) Report of State Employment Service Office Form
ES-21c (07-05) Report of State Employment Service Office Form ES-21c (07-05).pdf Form

Information Collection (IC) Details

IC Title:	Report of State Employment Service Office	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 325

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ES-21c (07-05)	Report of State Employment Service Office	Form ES-21c (07-05).pdf		No		Paper 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: 1,250	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	25	-1,225	1,250
Annual IC Time Burden (Hours)	1	-30	31
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.