Form ETA 9128 ETA 9128 Section IV Special Programs

UI REPORTS HANDBOOK NO. 401

ETA 9128 Reemployment and Eligibility Assessments Activities

CONTENTS

A. Facsimile of Form IV-8-2

B. Purpose IV-8-3

C. Due Date and Transmittal IV-8-3

D. General Reporting Instructions IV-8-3

E. Item by Item Instructions IV-8-3

1. Number of First REAs IV-8-3

2. Number of REAs Scheduled IV-8-3

3. Number of REAs Completed IV-8-4

4. Number Reporting for Reemployment Services or Training IV-8-4

5. Number Reporting for Reemployment Services IV-8-4

6. Number Reporting for Training. IV-8-4

7. Number of REAs Resulting in a Disqualification or Overpayment IV-8-4

8. Number of Disqualifications for a Separation Issue IV-8-4

9. Number of Disqualifications for Able and Available Issue IV-8-4

10. Number of Disqualifications for Disqualifying Income IV-8-4

11. Number of Disqualifications for Refusal of Suitable Work IV-8-4

12. Number of Disqualifications for Other Issues IV-8-4

13. Number of Completed REAs Resulting in an Overpayment IV-8-4

14. Dollar Amount of Overpayments Established IV-8-5

15. Number or REAs for which Claimant Failed to Appear IV-8-5

16. Number of REAs Rescheduled. IV-8-5

17. Number of Disqualifications for Failure to Report IV-8-5

18. Number of Failures to Report Disqualified for Other Issues IV-8-5

19. Number of Overpayments for Failure to Report IV-8-5

20. Dollar Amount of Overpayments for Failure to Report IV-8-5

21. Number Failed to Report with No Disqualification IV-8-5

22. Number Failed to Report Who Returned to Work IV-8-5

A. Facsimile of Form

ETA 9128 - Reemployment and Eligibility Assessment Workload

STATE	REGION	REPORT FOR PERIOD ENDING

1.	Number of Claimants Scheduled for Their First REA
2.	Number of All REAs Scheduled
3.	Number of REAs Completed
4.	Number Reporting to Reemployment Services or Training
5.	Number Reporting to Reemployment Services
6.	Number Reporting to Training
7.	Number of Completed REAs Resulting in A Disqualification or Overpayment
8.	Number Disqualified for A Separation Issue
9.	Number Disqualified for An Able And Available Issue
10.	Number Disqualifying/Deductible Income
11.	Number Disqualified for Refusal of Suitable Work Issue
12.	Number Disqualified for Issue(s) Other Than # 9 - 12
13.	Number Resulting in An Overpayment
14.	Dollar Amount of Overpayment Established
15.	Number of REAs for Which The Claimant Failed to Appear
16.	Number That Were Rescheduled Without Disqualification
17.	Number Disqualified for Failure to Report under Reporting Requirements
18.	Number Disqualified for Failure to Report under Issues Other Than Reporting Requirement
19.	Number That Resulted in An Overpayment
20.	Dollar Amount of Overpayment
21.	Number of Claimants That Failed to Report with no Disqualifications
22.	Number of Claimants That Returned to Work (If Available)

Comments:

O M B No.: 1205-0456      O M B Expiration Date: 05/31/2012      Estimated Average Response Time: 30 Minutes
O M B 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). 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.

B. Purpose

The ETA 9128 report provides quarterly information on the Reemployment and Eligibility Assessment (REA) activities of claimants who are selected for REAs. REAs provide in-person service in One Stop Career Centers for claimants including the development of an individualized work search plan, provision of appropriate labor market information (LMI) and referral to reemployment services as appropriate. The data on this report allows for evaluation and monitoring of the REA initiative on a national level.

C. Due Date and Transmittal

The electronically submitted report is due in the ETA National Office on the 20th of the second month following the quarter of reference (May 20, August 20, November 20, and February 20).

D. General Reporting Instructions

Data on this report deals with individuals in the regular Unemployment Insurance program. This includes regular Unemployment Insurance, Unemployment Compensation for Federal Employees (UCFE), and Unemployment Compensation for Ex-Servicemembers (UCX) who are selected for an REA. State Workforce Agencies (SWAs) should assure that systems are in place to collect information on service referrals.

Data are reported for the quarter in which the activity occurred. The activity being reported could occur in one or more quarters after the quarter in which the individual received an REA.

Individuals are counted only once in any single service category for either referred and reporting to services.

E. Item by Item Instructions

1. Number of first REAs. Enter the number of claimants who were scheduled for their first REA of their current benefit year during the report quarter.

2. Number of REAs scheduled. Enter the number of REAs for which an official notice was sent to the claimant instructing the claimant to report to the One Stop Career Center. This number includes both those scheduled REAs for which the claimant reported as directed, which are reported in item 3, and those scheduled REAs for which the claimant failed to report, which are reported in item15. It does not include those REAs that the claimant cancelled in advance and which were rescheduled with no disqualification.

3. Number of REAs completed. Enter the number of completed REAs to which the claimant reported as directed. Include REAs that were conducted for claimants who were rescheduled for an REA after missing an appointment. The sum of item 3 and item 15 should approximately equal item 2.

4. Number reporting for reemployment services or training. Enter the number of claimants reporting for reemployment services or training as a result of an REA. Claimants should be reported only once in items 5 or 6 below, not in both categories. Item 4 is the sum of item 5 and item 6.

5. Number reporting for reemployment services. Enter the number of claimants reporting for reemployment services as a result of referral from an REA.

6. Number reporting for training. Enter the number of claimants reporting for training as a result of referral from an REA.

7. Number of REAs resulting in a disqualification or overpayment. Enter the number of completed REAs from which a disqualification or overpayment occurs. Claimants who are both disqualified and for whom an overpayment occurs should only be counted once for each REA. The disqualification or overpayment must be the direct result of the completed REA.

8. Number of disqualifications for a separation issue. Enter the number of completed REAs from which a disqualification was issued based on a separation issue.

9. Number of disqualifications for able and available issues. Enter the number of completed REAs from which a disqualification was issued based upon an able and available issue.

10. Number of disqualifications for disqualifying income. Enter the number of completed REAs from which a disqualification was issued based upon disqualifying income.

11. Number of disqualifications for refusal of suitable work. Enter the number of completed REAs from which a disqualification was issued based upon the refusal of suitable work or refusal of a referral to suitable work.

12. Number of disqualifications for other issues. Enter the number of completed REAs from which a disqualification was issued based upon an issue not covered in items 8 thorough 11.

13. Number completed REAs resulting in an overpayment. Enter the number of completed REAs in which an overpayment was identified and officially established.

14. Dollar amount of overpayments established. Enter the total dollar amount of overpayments included in item 13.

15. Number of REAs for which claimant failed to report. Enter the number of REAs in which a claimant was scheduled to report and failed to do so. This number includes those claimants who were sent an official notice to report for an REA and who did not report as directed. It includes claimants who failed to report and who were subsequently rescheduled for an REA at a different time. It does not include REAs that were cancelled in advance by the claimant and for which no disqualification was issued. REAs counted in this item should also be counted in items 16, 17, 18, or 21. The sum of item 15 and item 3 should approximately equal item 2.

16. Number of REAs rescheduled. Enter the number of REAs for which a claimant failed to report which were rescheduled without disqualification.

17. Number of disqualifications for failure to report. Enter the number of REAs for which the claimant failed to report and for which the claimant was disqualified for failing to meet the reporting requirements of state law.

18. Number of failures to report disqualified for other issues. Enter the number of REAs for which the claimant failed to report and for which the claimant was disqualified for an issue other than the failure to report.

19. Number of overpayments for failure to report. Enter the number of REAs for which an overpayment was established due the failure to report for the REA.

20. Dollar amount of overpayments for failure to report. Enter the total dollar amount of overpayment dollars established in 19 above.

21. Number failed to report with no disqualification. Enter the number of REAs for which the claimant failed to report and for which no disqualification was issued.

22. Number failed to report who returned to work. Enter the number of claimants who failed to report, identified in item 21 above, as a result of having returned to work.

IV-8-5

4/2007