Information Collection

State Wage Records Request Form

IC 274508 under ICR 202503-1220-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SW-RF-25 State Wage Records Request Form	Form
Form SW-RF-25 State Wage Records Request Form State Wage Records Request Form	Form
Wage Records Request Form Instructions.docx	Instruction
Wage Records Request Form Instructions.docx	Instruction
SW-RF-25 State Wage Records Request Form State_Wage_Records_Request_Form.docx	Form
SW-RF-25 State Wage Records Request Form State_Wage_Records_Request_Form.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	SW-RF-25				Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	3	3
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.

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