Benefit Appeals Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0172 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 5130 Benefit Appeals Report Form and Instruction
ETA 5130 Benefit Appeals Report ETA 5130 Handbook 401.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Benefit Appeals Report	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 5130	Benefit Appeals Report	ETA 5130 Handbook 401.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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,272	-636	1,908
Annual IC Time Burden (Hours)	1,272	-636	1,908
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.