Multiple Worksite Report and the Report of Federal Employment and Wages

Forms and Documents

Document Name	Status
Form BLS 3020 Multiple Worksite Report (Voluntary) Form and Instruction	New
Form BLS 3020 Multiple Worksite Report (Mandatory) Form and Instruction	New
Form BLS 3021 Report of Federal Employment and Wages Form and Instruction	Modified
Supporting Statement A (1220-0134).doc Supporting Statement A	2007-03-22
Attachment B.pdf Supplementary Document	2007-01-22
Attachment F.doc Supplementary Document	2007-01-22
Attachment E.pdf Supplementary Document	2007-01-22
Attachment A.doc Supplementary Document	2007-01-22
Supporting Statement B (1220-0134).doc Supporting Statement B	0000-00-00

IC Document Collections

IC ID	Document Title	Status
178402	Multiple Worksite Report (Voluntary) Form and Instruction	New
178400	Multiple Worksite Report (Mandatory) Form and Instruction	New
14636	Report of Federal Employment and Wages Form and Instruction	Modified

ICR Details

OMB Control No: 1220-0134	ICR Reference No: 200701-1220-001
Status: Historical Active	Previous ICR Reference No: 200401-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Multiple Worksite Report and the Report of Federal Employment and Wages
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/26/2007
	Date Received in OIRA: 02/22/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved	03/31/2007
Responses	513,644	0	472,984
Time Burden (Hours)	190,048	0	173,523
Cost Burden (Dollars)	0	0	0

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Abstract: States use the Multiple Worksite Report to collect employment and wages data by worksite from employers covered by State Unemployment Insurance which are engaged in multiple operations within a State. These data are used for sampling, benchmarking, and economic analysis.

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Authorizing Statute(s): US Code: 29 USC 1 & 2 Name of Law: BLS Authorizing Statute
   US Code: 42 USC 503 Name of Law: State Laws
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 64743	11/03/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 8018	02/22/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Multiple Worksite Report (Voluntary)	BLS 3020	Multiple Worksite Report
Report of Federal Employment and Wages	BLS 3021	Report of Federal Employment and Wages
Multiple Worksite Report (Mandatory)	BLS 3020	Multiple Worksite Report

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ICR Summary 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	513,644	472,984	0	0	40,660	0
Annual Time Burden (Hours)	190,048	173,523	0	0	16,525	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in burden represents an economic expansion of the total number of businesses in the U.S. economy with multiple worksite locations.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/22/2007

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