Information Collection

Certification Regarding Rights to Unemployment Benefits

IC 181719 under ICR 201011-3220-002 · OMB 3220-0079.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0079 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form UI-45 (01-08) Certification Regarding Rights to Unemployment Benefits	Form
UI-45 (01-08) Certification Regarding Rights to Unemployment Benefits Form UI-45 (01-08).pdf	Form

IC Title:

Certification Regarding Rights to Unemployment Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 320.5

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	UI-45 (01-08)	Certification Regarding Rights to Unemployment Benefits	Form UI-45 (01-08).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title: RRB-6, Unemployment Insurance Benefits

FR Citation: 75 FR 43716

Number of Respondents: 950

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	950	950
Annual IC Time Burden (Hours)	79	79
Annual IC Cost Burden (Dollars)	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.