Information Collection

Placement Service

IC 33872 under ICR 202311-3220-002 · OMB 3220-0057.

Documents and Forms

Document Name Document Type
Form ES-21 (11-07) Placement Service Form
ES-21 (11-07) Referral to State Employment Service Form ES-21 (11-07).pdf Form
ES-21 (11-07) Referral to State Employment Service Form ES-21 (11-07).pdf Form
UI-35 (08-23) Field Office Record of Claimant Interview Form UI-35 (08-23).pdf Form
UI-35 (08-23) Field Office Record of Claimant Interview Form UI-35 (08-23).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Placement Service	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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-21 (11-07)	Referral to State Employment Service	Form ES-21 (11-07).pdf		No		Paper Only
Form	UI-35 (08-23)	Field Office Record of Claimant Interview	Form UI-35 (08-23).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 benfit System	FR Citation: 79 FR 58874

Number of Respondents: 7,080	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,080	7,080
Annual IC Time Burden (Hours)	864	864
Annual IC Cost Burden (Dollars)	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.