Information Collection

Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers

IC 43787 under ICR 201510-1205-009 · OMB 1205-0162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0162 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 191 Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers	Form
ETA 191 ETA 191 - STATEMENT OF EXPENDITURES & FINANCIAL ADJS OF ETA 191.pdf	Form
ETA 191 ETA 191 Statement of Expenditures and Financial Adjustme ETA 191 Form and Instructions.doc	Form and Instruction

IC Title:

Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 191	ETA 191 - STATEMENT OF EXPENDITURES & FINANCIAL ADJS OF FEDERAL FUNDS FOR UC FOR UCFE-UCX	ETA 191.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 191	ETA 191 Statement of Expenditures and Financial Adjustments of Federal Funds for UCFE/UCX	ETA 191 Form and Instructions.doc		Yes	Yes	Fillable Fileable

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	1,272	1,272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.