Form ETA 902A ETA 902A Gulf Oil Spill Activity Report

Attachment B—Data Collection For Oil Spill

ETA 902-A: 2010 Gulf Oil Spill Activity Report

State:

Report for Period Ending:

Section A. Application and Payment Activities

Line Number.

Initial Claims

First Payments

Weeks Claimed

Weeks Compensated

Benefits Paid.

1

2

3

4

5

Claimants

101

Section B. Denial and Appeals Activity

Line Number.

Weeks Denied

Appeals Filed

Appeals Disposed

In Favor of Claimant

6

7

8

9

Claimants

201

Section C. Overpayment Activity and Administration

Line Number

Overpayments

Administrative Costs

Cases

Weeks

Amount

Personnel

N P S

AS&T

10

11

12

13

14

15

Claimants

301

O M B No.: 1205-0051 O M B Expiration Date: 07/31/2011 Estimated average response time: 1 hour

Public Burden Statement: These reporting instructions have been approved under the Paperwork reduction Act of 1995. Persons are not required to respond to this collection of information unless it displays a valid OMB control number. Public reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Submission is required to obtain or retain benefits under SSA 303(a)(6). This is public information and there is no expectation of confidentiality. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Workforce Security, Room S-4231, 200 Constitution Ave., NW, Washington, DC, 20210.

1. State. Enter the two-letter FIPS State Alpha Code (identical to the two-letter U.S. Postal Service abbreviation).

2. Report Period Ended. Enter the month; last day of the month to which data relates; and four digit year to which the data relates; e.g., 10/31/2010.

3. Column 1, Initial Applications. Enter the number of initial applications for oil spill-related benefits taken during the report period. This will equal the number of forms used by the State agency for filing initial applications that were completed and/or number of applications entered into an automated system through an electronic/telephone claims taking system during the report period.

4. Column 2, Number Determined Eligible. First Payments. Enter the number of payments which represent, for any individual, the first week for which assistance is paid oil spill-related benefits.

5. Column 3, Weeks Claimed. Enter the total numbers of weeks for which oil spill-related benefits are claimed during the report period, whether or not the benefits were actually paid. If claims are filed weekly, the number of weeks will equal the number of weekly claim forms or weekly claims filed by telephone or other means received during the report period. If claims are filed other than weekly, the number of weeks will equal number of weeks claimed on forms or by telephone or other means during the report period.

6. Column 4, Weeks Compensated. Enter the number of weeks of unemployment for which oil spill-related benefits were paid during the report period. A week of unemployment compensated is any week of unemployment for which oil spill-related benefits are paid, regardless of amount.

7. Column 5, Amount Compensated. Enter the amount of oil spill-related benefits represented by the weeks reported in column 4.

8. Column 6, Weeks Denied. Enter the number of weeks of unemployment where an oil spill-related payment was denied for which an individual, except for the reason of the denial, would have been eligible to receive a oil spill-related payment

9. Column 7, Appeals Filed. In column 7, indicate the number of appeal cases or requests for review received during the month.

10. Column 8, Appeals Disposed. Enter in column 8, the total number of cases decided during the month

11. Column 9, In Favor of Claimant. Enter in column 9, the total number of appeal cases decided during the month.

12. Column 10, Cases, enter in column 10, enter the number of cases, including willful misrepresentation (fraud) determined during the report period as an overpayment, regardless of when it occurred.

13. Column 11 Weeks, enter in column 11, the number of weeks of oil spill-related benefits made in overpayment.

14. Column 12, Amount, enter in column 12, the amount overpaid represented by cases reported in column 11.

15. Column 13. Personnel Costs (PC), the amount of personal service (salary) costs and personnel benefits (health, retirement, etc.) costs for individuals directly related to oil spill-related benefit payments.

16. Column 14. NPS, enter the total dollars expended for non-personal service costs (e.g. supplies, travel, equipment, etc.).

17. Column 15. AS&T, enter the total AS&T costs for staff performing to support the staff reported in column 13.

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