CONTENTS

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CONTENTS

A.	Facsimile of Forms 	IV-X-2
B.	Purpose	IV-X-5
C.	Due Date and Transmittal	IV-X-5 
D.	General Reporting Instructions	IV-X-5
E.	Definitions	IV-X-5
F.	Item by Item Instructions	IV-X-5

















    A. Facsimile of Form

ETA 9161: Self Employment Assistance (Regular Program)

STATE
REGION
REPORT FOR PERIOD ENDING


calendar quarter end date

Section A: Claimants referred to SEA

    1. Claimants Participating in and Receiving Benefits from SEA
C1
    2. Benefits Paid to all SEA Claimants
C2
    3. Claimants in SEA who Discontinue Participation
C3
    4. Claimants in SEA who Receive a Final Payment
C4

Section B: SEA Outcomes

    5. Number of Establishments created by SEA Claimants
C5
    6. Cumulative Number of SEA Establishments Operating
C6
    7. Individuals Employed by SEA Establishments
C7
    8. Gross Revenues Earned by SEA Establishments
C8
    9. Wages Paid to individuals by SEA Establishments
C9


Comments:
 
OMB No.: 1205-0490	OMB Expiration Date: 10/31/2015        Estimated Average Response Time: 2 Hours

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 retain or obtain benefits under SSA 303(a)(6) (42 U.S.C. 503(a)) and Pub. L. 112-96 section 2183(b)(1).  Respondents have no expectation of confidentiality.  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-4526, 200 Constitution Ave., NW, Washington, DC, 20210.
ETA 9161: Self Employment Assistance (Extended Benefits Program)

STATE
REGION
REPORT FOR PERIOD ENDING


calendar quarter end date

Section A: Claimants referred to SEA

    10. Claimants Participating in and Receiving Benefits from SEA
C1
    11. Benefits Paid to all SEA Claimants
C2
    12. Claimants in SEA who Discontinue Participation
C3
    13. Claimants in SEA who Receive a Final Payment
C4

Section B: SEA Outcomes

    14. Number of Establishments created by SEA Claimants
C5
    15. Cumulative Number of SEA Establishments Operating
C6
    16. Individuals Employed by SEA Establishments
C7
    17. Gross Revenues Earned by SEA Establishments
C8
    18. Wages Paid to individuals by SEA Establishments
C9


Comments:
 
OMB No.: 1205-0490	OMB Expiration Date: 10/31/2015        Estimated Average Response Time: 2 Hours

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 retain or obtain benefits under SSA 303(a)(6) (42 U.S.C. 503(a)) and Pub. L. 112-96 section 2183(b)(1).  Respondents have no expectation of confidentiality.  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-4526, 200 Constitution Ave., NW, Washington, DC, 20210.
B.  	Purpose

The ETA 9161 report is intended to provide a description of the scope of activities states engage in supporting Self Employment Assistance (SEA) for UI Claimants in the Regular and Extended Benefits Programs.  It contains quarterly information on claimants who begin and exit the program.

C.	Due Date and Transmittal.

The report is due in the ETA National Office on the first day of the second month following each calendar quarter to which it relates.  

D.	General Reporting Instructions.

This report summarizes claimant activity in the SEA program.  Claimants subject to reporting include anyone who is eligible to receive a week of payment in the SEA program as administered by the state. There are program specific forms to accommodate reporting for SEA participants in the regular program and the Federal State Extended Benefits program.  States should ensure that reporting activity is recorded on the correct form by program type.

States should ensure that they are able to capture the necessary outcome data from the SEA program as requested on the form.  In many cases, the only effective way to accomplish this is to build into the claimant’s SEA agreement a responsibility to follow up with the state and to provide data on the continued operation of their establishment, whether it employs people and what wages these people are paid, and what sorts of revenues the establishment may be generating.  States should not rely on UI wage records or state business tax records, as many self-employed individuals may not be represented in those systems and would go under-reported.

E.	Definitions

Establishment:  For the purposes of this report, states should use the definition of establishment provided by the Bureau of Labor Statistics for the Current Employment Statistics Survey.  An establishment is an economic unit, such as a factory, mine, store, or office that produces goods or services. It generally is at a single location and is engaged predominantly in one type of economic activity. Where a single location encompasses two or more distinct activities, these are treated as separate establishments, if separate payroll records are available, and the various activities are classified under different industry codes.  

F.	Item by Item Instructions	

    1. Claimants Participating in and Receiving Benefits from SEA: Provide the number of claimants who are part of the state’s SEA program and received at least one check during the reporting period.  Do not include counts of claimants who attended an orientation, or made inquiries about SEA or were referred to the program but never formally entered the program. Include counts of claimants who entered the program and received at least one payment but were subsequently disqualified for monetary or non-monetary reasons.
    2. Benefits Paid to all SEA Claimants: Provide the total benefits paid during the report period to all claimants participating in the state SEA program.
    3. Claimants in SEA who Discontinue Participation: Enter the number of claimants who chose to leave the SEA program, or who were removed from the program due to monetary or non-monetary eligibility issues.
    4. Claimants in SEA who Receive a Final Payment: enter the number of claimants who entered the state SEA program and received a payment that reduced their account balance to zero in the program in which they are claiming benefits.
    5. Number of Establishments created by SEA Claimants: Enter the number of establishments created by SEA claimants.
    6. Number of SEA Establishments Operating: Report the number of establishments that were created by claimants in the SEA program in prior reporting periods that continue to operate during the current reporting period.
    7. Individuals Employed by SEA Establishments: Report the number of people employed by SEA establishments identified in items 5 and 6 above.  Including the SEA participant in the total reported.  
    8. Gross Revenues Earned by SEA Establishments: Report the gross revenues earned by SEA Establishments identified in items 5 and 6 above.
    9. Wages Paid by SEA Establishments: Report the amount of wages and compensation paid to individuals, including the SEA participant, reported as employed by SEA establishments identified in items 5 and 6 above.