Information Collection Request

Employer Service and Compensation Reports

ICR 202507-3220-002 · OMB 3220-0070 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form UI-41a (XX-XX) - P Supplemental Report of Compensation Form Modified Available
Form UI-41a (XX-XX) - P Supplemental Report of Compensation Form Modified Repair queued
Form UI-41 (XX-XX) - Pr Supplemental Report of Service and Compensation Form Modified Available
Form UI-41 (XX-XX) - Pr Supplemental Report of Service and Compensation Form Modified Repair queued
Form UI-41a (07-19) Supplemental Report of Compensation Form Modified Available
Form UI-41a (07-19) Supplemental Report of Compensation Form Modified Available
Form UI-41 (08-17) Supplemental Report of Service and Compensation Form Modified Available
Form UI-41 (08-17) Supplemental Report of Service and Compensation Form Modified Available
3220-0070_Final.docx Supporting Statement A Uploaded 2026-02-03 Available
3220-0070_Final.docx Supporting Statement A Uploaded 2026-02-03 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Service and Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Service and Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Service and Compensation
33875 Employer Service and Compensation Reports Form ModifiedSupplemental Report of Service and Compensation
33875 Employer Service and Compensation Reports Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2029 36 Months From Approved 05/31/2026
380 0 150
51 0 20
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Employer Service and Compensation Reports UI-41 (XX-XX) - Proposed, UI-41a (XX-XX) - Proposed, UI-41 (08-17), UI-41a (07-19) ,   ,   ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 380 150 0 0 230 0
Annual Time Burden (Hours) 51 20 0 0 31 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No