Information Collection

Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284

IC 43788 under ICR 200907-1205-011 · OMB 1205-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0176 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-843 Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284	Form and Instruction
ETA-843 Request for Military Documentation for Unemployment Comp ETA 843 Form.doc	Form and Instruction
ETA-841 Request for Determination of Federal Military Service an ETA 841 Form.doc	Form and Instruction

IC Title:

Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-843	Request for Military Documentation for Unemployment Compensation Purposes	ETA 843 Form.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA-841	Request for Determination of Federal Military Service and Wages	ETA 841 Form.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,297	0	0	5,297
Annual IC Time Burden (Hours)	88	0	33	55
Annual IC Cost Burden (Dollars)	0	-37,000	0	37,000

Documents for IC

table that charts IC Documents
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.