Information Collection Request

Employer Service and Compensation Reports

ICR 202301-3220-002 · OMB 3220-0070 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form UI-41a (07-19) Supplemental Report of Compensation Form Modified Available
Form UI-41 (08-17) Supplemental Report of Service and Compensation Form Modified Available
Form UI-41 (08-17) Employer Service and Compensation Reports Form Modified Repair queued
3220-0070.docx Supporting Statement A Uploaded 2023-01-24 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Service and Compensation
33875 Employer Service and Compensation Reports Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2026 36 Months From Approved 03/31/2023
150 0 150
20 0 20
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Employer Service and Compensation Reports UI-41 (08-17), UI-41a (07-19) ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 150 150 0 0 0 0
Annual Time Burden (Hours) 20 20 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No