Benefit Rights and Experience Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 218 Federal-State EB Claimants	Form and Instruction	New	Available
Form ETA 218 Regular Program Claimants	Form and Instruction	Modified	Available
1205-0177 Supporting Statement_FINAL 8.2.16.docx	Supporting Statement A	Uploaded 2016-08-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219248	Federal-State EB Claimants	Form and Instruction	New
13018	Regular Program Claimants	Form and Instruction	Modified

ICR Details

OMB Control No: 1205-0177	ICR Reference No: 201512-1205-002
Status: Historical Active	Previous ICR Reference No: 201212-1205-008
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Benefit Rights and Experience Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/09/2016
	Date Received in OIRA: 03/08/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	08/31/2016
Responses	216	0	636
Time Burden (Hours)	108	0	318
Cost Burden (Dollars)	0	0	0

---

Abstract: The data in the ETA 218, Benefit Rights and Experience Report, includes numbers of individuals who were and were not monetarily eligible, those eligible for the maximum benefits, those eligible based on classification by potential duration categories, and those exhausting their full entitlement as classified by actual duration categories. This data is collected as part of the initial claim process. It is transmitted electronically to the National Office on a quarterly basis. This data is used by the National Office in solvency studies, cost estimating and modeling, and to assess State benefit formulas. If this data were not available, cost estimating and modeling would be less accurate.

---

Authorizing Statute(s): US Code: 42 USC 503(a)(6) Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 58299	09/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 12129	03/08/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Regular Program Claimants	ETA 218	Section 1 Claimant Activity: Benefit Rights and Experience
Federal-State EB Claimants	ETA 218	Section 1 Claimant Activity: Benefit Rights and Experience

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	216	636	0	-420	0	0
Annual Time Burden (Hours)	108	318	0	-210	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden estimates were revised due to the ending of the Emergency Unemployment Compensation (EUC) program on December 2013. Previously information was collected for participants eligible for EUC, since the program has expired and authorization that portion of data collection is no longer necessary.

---

Annual Cost to Federal Government: $26,367

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/08/2016

---