Information Collection

Benefits Timeliness and Quality Review System

IC 13147 under ICR 201010-1205-005 · OMB 1205-0359.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0359 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9050 First Payment Time Lapse Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA-9051 Continued Weeks Compensated Time Lapse Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA 9052 Nonmonetary Determination TIme Lapse Detection Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA 9054 Appeals Time Lapse Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA 9055 Appeals Case Aging Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA 9056 Nonmonetary Determination Quality Review Benefits Timeliness and Quality Review System	Form and Instruction
Form ETA 9057 Lower Authority Appeals Quality Review Benefits Timeliness and Quality Review System	Form and Instruction
ETA 9050 First Payment Time Lapse SectionV_Benefits_TimeLapse_and_Quality_ETA 9050_Change_1.doc	Form and Instruction
ETA-9051 Continued Weeks Compensated Time Lapse SectionV_Benefits_TimeLapse_and_Quality_ETA 9051.doc	Form and Instruction
ETA 9052 Nonmonetary Determination TIme Lapse Detection SectionV_Benefits_TimeLapse_and_Quality_ETA 9052.doc	Form and Instruction
ETA 9054 Appeals Time Lapse SectionV_Benefits_TimeLapse_and_Quality_ETA 9054.doc	Form and Instruction
ETA 9055 Appeals Case Aging SectionV_Benefits_TimeLapse_and_Quality_ETA 9055.doc	Form and Instruction
ETA 9056 Nonmonetary Determination Quality Review SectionV_Benefits_TimeLapse_and_Quality_ETA 9056.doc	Form and Instruction
ETA 9057 Lower Authority Appeals Quality Review SectionV_Benefits_TimeLapse_and_Quality_ETA 9057.doc	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Benefits Timeliness and Quality Review System

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9050	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9051	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9052	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9054	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9055	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9056	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9057	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	29,976	1,064	28,912
Annual IC Time Burden (Hours)	39,892	2,360	37,532
Annual IC Cost Burden (Dollars)	0	0	0

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.

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