Supplementary Budget Request Activities

Unemployment Insurance Supplemental Budget Request Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0517 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-9165 Supplementary Budget Request Activities Form and Instruction
ETA-9165 Quarterly Reporting Form for Supplemental Activities 1205-0NEW_ETA-9165_Reporting_Instructions_ETA-9165_CLEAN.tr20150107.doc Form and Instruction
ETA-9165 Quarterly Narrative Progress Report ETA Form-9165 Quarterly Narrative Progress Report_ETA 9165 gg.docx Form

Information Collection (IC) Details

IC Title:	Supplementary Budget Request Activities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9165	Quarterly Reporting Form for Supplemental Activities	1205-0NEW_ETA-9165_Reporting_Instructions_ETA-9165_CLEAN.tr20150107.doc		Yes	Yes	Fillable Printable
Form	ETA-9165	Quarterly Narrative Progress Report ETA Form-9165	Quarterly Narrative Progress Report_ETA 9165 gg.docx		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	1,237	1,237
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.