Information Collection

Request for Employment Information

IC 13773 under ICR 202504-1240-001 · OMB 1240-0047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CA-1027 Request for Employment Information	Form and Instruction
Form CA-1027 Request for Employer Information Request for Employment Information	Form and Instruction
CA-1027 Request for Employer Information CA1027 final Form.docx	Form and Instruction
CA-1027 Request for Employer Information CA1027 final Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	CA-1027				No		Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/GOVT-1

FR Citation: 81 FR 47418

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	0	10
Annual IC Time Burden (Hours)	3	0	3
Annual IC Cost Burden (Dollars)	8	2	6

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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