Information Collection

A-establishment Information, B-wage Data, C-quarterly Report D-benefit Document, E-benefit Change Document, 3076 Refinement Survey

IC 123604 under ICR 197702-1220-004 · OMB 1220-0038.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0038 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	A-ESTABLISHMENT INFORMATION, B-WAGE DATA, C-QUARTERLY REPORT D-BENEFIT DOCUMENT, E-BENEFIT CHANGE DOCUMENT, 3076 REFINEMENT SURVEY	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	A-3038A,B,C,	No	No
Form	D,E 3076	No	No
Form	3038C	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,362	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11,362	2,562	8,800
Annual IC Time Burden (Hours)	17,272	8,472	8,800
Annual IC Cost Burden (Dollars)	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.