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Claim's Agents And Claimant's Statement Re: Benefits For Days Worked By Claimants
CLAIM'S AGENTS AND CLAIMANT'S STATEMENT RE: BENEFITS FOR DAYS WORKED BY CLAIMANTS
OMB: 3220-0081
IC ID: 177081
OMB.report
RRB
OMB 3220-0081
ICR 198004-3220-011
IC 177081
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0081 can be found here:
1981-03-21 - No material or nonsubstantive change to a currently approved collection
1981-02-19 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CLAIM'S AGENTS AND CLAIMANT'S STATEMENT RE: BENEFITS FOR DAYS WORKED BY CLAIMANTS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
UI-48,
No
No
Form
UI-54
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,200
0
0
0
0
1,200
Annual IC Time Burden (Hours)
200
0
0
0
0
200
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.