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

Statement of Expenditures and Financial Adjustments of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Service members

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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 191 508-compliant.pdf Form
ETA 191 ETA 191 Statement of Expenditures and Financial Adjustme ETA 191 UI REPORT HANDBOOK NO.401.docx Form and Instruction

Information Collection (IC) Details

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:

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 191 508-compliant.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 UI REPORT HANDBOOK NO.401.docx		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	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

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.