Information Collection

Establishment Information Form, Wage Data Collection Form and Continuation Form

IC 33552 under ICR 199709-3206-002 · OMB 3206-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3206-0036 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Establishment Information Form, Wage Data Collection Form and Continuation Form	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	VA5-4684	No	No
Form	VA5-4685A	No	No
Form	DD-1918	No	No
Form	DD-1919C	No	No
Form	DD-1919	No	No
Form	VA5-4685	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,200	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21,200	21,200
Annual IC Time Burden (Hours)	75,800	75,800
Annual IC Cost Burden (Dollars)	1,097,000	1,097,000

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.