Information Collection

Quarterly Reporting

IC 201795 under ICR 201211-1205-002 · OMB 1205-0492.

Documents and Forms

Document Name Document Type
Collection of Evaluation Data Elements.doc Other-evaluation data elements
Demonstration Quarterly Report requirements.doc Other-quarterly report requirements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Quarterly Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-evaluation data elements			Collection of Evaluation Data Elements.doc		Yes	Yes	Fillable Fileable
Other-quarterly report requirements			Demonstration Quarterly Report requirements.doc		Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	40	0	40
Annual IC Time Burden (Hours)	3,200	0	3,200
Annual IC Cost Burden (Dollars)	0	-131,168	131,168

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.