Information Collection

QW and UI: States

IC 179586 under ICR 202507-0970-004 · OMB 0970-0166.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 QW and UI: States	Form and Instruction
Form 1 Quarterly Wage Record & Unemployment Insurance Record Layout QW and UI: States	Form and Instruction
1 Quarterly Wage Record & Unemployment Insurance Record La 0970-0166_NDNH Record Specs_032125.docx	Form and Instruction
1 Quarterly Wage Record & Unemployment Insurance Record La 0970-0166_NDNH Record Specs_032125.docx	Form and Instruction

IC Title:

QW and UI: States

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1				Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,484	1,484
Annual IC Time Burden (Hours)	0	0
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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