Information Collection

Reemployment and Eligibility Assessment Program

IC 13320 under ICR 201203-1205-007 · OMB 1205-0456.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0456 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9128 Reemployment and Eligibility Assessment Program	Form and Instruction
ETA 9128 Section IV Special Programs SectionIV_SpecialPrograms_ETA 9128 2012.doc	Form and Instruction
ETA 9129 Section IV Special Programs SectionIV_SpecialPrograms_ETA 9129 2012.doc	Form and Instruction

IC Title:

Reemployment and Eligibility Assessment Program

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 9128	Section IV Special Programs	SectionIV_SpecialPrograms_ETA 9128 2012.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9129	Section IV Special Programs	SectionIV_SpecialPrograms_ETA 9129 2012.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41

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	328	184	144
Annual IC Time Burden (Hours)	164	128	36
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.