Information Collection

Multistate Employer Registration Form

IC 179589 under ICR 202209-0970-012 · OMB 0970-0166.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0166 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Multistate Employer Registration Form	Form and Instruction
1 MSER Form 09_23_22_0970-0166_MSER Form_OMB_Exp_07312025.pdf	Form and Instruction
1 MSER Form 09_23_22_0970-0166_MSER Form_OMB_Exp_07312025.pdf	Form and Instruction

IC Title:

Multistate Employer Registration Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 and Instruction	1	MSER Form	09_23_22_0970-0166_MSER Form_OMB_Exp_07312025.pdf		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,118

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,118	1,118
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	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.