Participant Disclosures to States

Self-Employment Assistance of the Federal Emergency Unemployment Compensation Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0490 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9161 A,B,C Participant Disclosures to States Form and Instruction
ETA 9161 A,B,C Self EMployment Assistance reporting_instructions_ETA9161__SEA_final.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Participant Disclosures to States	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9161 A,B,C	Self EMployment Assistance	reporting_instructions_ETA9161__SEA_final.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,400	-65,600	72,000
Annual IC Time Burden (Hours)	3,200	-32,800	36,000
Annual IC Cost Burden (Dollars)	0	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.