State Wage Records Request Form

BLS Wage Records Data Application

Documents and Forms

Document Name Document Type
Form SW-RF-25 State Wage Records Request Form Form
Wage Records Request Form Instructions.docx Instruction
SW-RF-25 State Wage Records Request Form State_Wage_Records_Request_Form.docx Form

Information Collection (IC) Details

IC Title:	State Wage Records Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SW-RF-25	State Wage Records Request Form	State_Wage_Records_Request_Form.docx		Yes	Yes	Fillable Fileable
Instruction			Wage Records Request Form Instructions.docx		Yes	Yes	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.