Information Collection

Report of State Employment Service Office

IC 181794 under ICR 201702-3220-001 · OMB 3220-0057.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.