Information Collection Request

Certification Regarding Rights to Unemployment Benefits

ICR 201312-3220-001 · OMB 3220-0079 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form UI-45 (01-08) Certification Regarding Rights to Unemployment Benefits Form Modified Available
Form UI-45 (01-08) Certification Regarding Rights to Unemployment Benefits Form Removed Repair queued
Form UI-1 (03-12).pdf Supplementary Document Uploaded 2014-02-28 Available
Form UI-3 (02-09).pdf Supplementary Document Uploaded 2014-02-28 Available
Chapter_315.pdf Supplementary Document Uploaded 2007-08-28 Available
3220-0079.doc Supporting Statement A Uploaded 2014-02-28 Available
Form UI-33 (08-13).pdf Supplementary Document Uploaded 2014-02-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
33878 Certification Regarding Rights to Unemployment Benefits Form Modified
181719 Certification Regarding Rights to Unemployment Benefits Form Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 03/31/2014
200 0 2,900
50 0 487
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Certification Regarding Rights to Unemployment Benefits UI-45 (01-08) Claimant's Statement - Voluntary Leaving of Work
Certification Regarding Rights to Unemployment Benefits UI-45 (01-08) Certification Regarding Rights to Unemployment Benefits

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 200 2,900 0 -950 -1,750 0
Annual Time Burden (Hours) 50 487 0 -79 -358 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No