Form ETA 9128X ETA 9128X Section IV Special Programs

ETA 9128 X - Reemployment Services and Eligibility Assessments (RESEAs) for Unemployment Compensation for Ex-Servicemembers (UCX) Workload

STATE	REGION	REPORT FOR PERIOD ENDING

1.	Number of Claimants Scheduled for Their First RESEA
2.	Number of All RESEAs Scheduled
3.	Number of RESEAs Completed
4.	Number Reporting to Reemployment Services or Training
5.	Number Reporting to Reemployment Services
6.	Number Reporting to Training
7.	Number of Completed RESEAs Resulting in A Disqualification or Overpayment
8.	Number Disqualified for A Separation Issue
9.	Number Disqualified for An Able And Available Issue
10.	Number Disqualifying/Deductible Income
11.	Number Disqualified for Refusal of Suitable Work Issue
12.	Number Disqualified for Issue(s) Other Than # 8 - 11
13.	Number Resulting in An Overpayment
14.	Dollar Amount of Overpayment Established
15.	Number of RESEAs for Which The Claimant Failed to Appear
16.	Number That Were Rescheduled Without Disqualification
17.	Number Disqualified for Failure to Report under Reporting Requirements
18.	Number Disqualified for Failure to Report under Issues Other Than Reporting Requirement
19.	Number That Resulted in An Overpayment
20.	Dollar Amount of Overpayment
21.	Number of Claimants That Failed to Report with no Disqualifications
22.	Number of Claimants That Returned to Work (If Available)

Comments:

O M B No.: 1205-0456      O M B Expiration Date: 01/31/2016      Estimated Average Response Time: 30 Minutes
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 obtain or retain benefits under SSA