Information Collection

Placement Service

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

Documents and Forms

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

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.