Benefit Rights and Experience Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 218 Benefit Rights and Experience Report	Form and Instruction	Modified	Available
supporting_statement_1205-0177_Benefit_Rights_and_Experience final 3 11 2013.docx	Supporting Statement A	Uploaded 2013-03-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13018	Benefit Rights and Experience Report	Form and Instruction	Modified

ICR Details

OMB Control No: 1205-0177	ICR Reference No: 201212-1205-008
Status: Historical Active	Previous ICR Reference No: 201004-1205-002
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Benefit Rights and Experience Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/15/2013
	Date Received in OIRA: 03/19/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	36 Months From Approved	06/30/2013
Responses	636	0	216
Time Burden (Hours)	318	0	108
Cost Burden (Dollars)	0	0	0

---

Abstract: Provides information used in solvency studies, in budgeting projections and for evaluation of adequacy of benefit formulas to analyze effects or proposed changes in state law.

---

Authorizing Statute(s): US Code: 42 USC 503(a)(6) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 69503	11/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 16870	03/19/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Benefit Rights and Experience Report	ETA 218	Section 1 Claimant Activity: Benefit Rights and Experience

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	636	216	0	0	420	0
Annual Time Burden (Hours)	318	108	0	0	210	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Previously, this collection claimed burden for 53 SWAs to provide quarterly reports in the regular program and 2 SWAs to provide 2 quarterly reports in the EB program which is episodic. This produced a total burden of 108 hours. This collection predated the great recession and federal laws establishing additional Federal benefit programs, as well as paying the state cost of the EB program, which caused an increase in the number of states establishing EB entitlement. This report collects data on the status of eligibility determinations and the entitlement created and used in the UI program. When additional benefit programs become active, states must provide additional reports. For the EB program, the previous burden total was two hours but the projected burden estimate is now 106 for a difference of 104 hours. For the EUC 2008 program, there was no burden claimed previously, so the current burden estimates include 53 SWAs submitting 4 quarterly reports in that program, for a difference of 106 hours. The total difference from the last submittal is an increase of 104 hours in EB reporting and an increase of 106 hours in EUC 2008 reporting for an increase of 210 hours.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/19/2013

---