Unemployment Compensation for Ex-Servicemembers Handbook

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 843 Request for Military Documentation for UCX	Form and Instruction	Modified	Available
Form ETA 841 Request for Determination of Federal Military Service and Wages—UCX	Form	Removed	Available
ETAHandbook384_Att1 a10-a12.pdf	Supplementary Document	Uploaded 2016-03-07	Available
1205-0176 FINAL Supporting Statement 2019-09-10.docx	Supporting Statement A	Uploaded 2019-09-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43788	Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284	Form and Instruction	Modified	Request for Military Documentation for UCX
220501	Request for Determination of Federal Military Service and Wages-UCX	Form	Removed	Request for Determination of Federal Military Service and Wages—UCX

ICR Details

OMB Control No: 1205-0176	ICR Reference No: 201906-1205-003
Status: Historical Active	Previous ICR Reference No: 201510-1205-005
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Unemployment Compensation for Ex-Servicemembers Handbook
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: 09/10/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/28/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2022	36 Months From Approved	09/30/2019
Responses	2,711	0	107,816
Time Burden (Hours)	226	0	2,139
Cost Burden (Dollars)	0	0	0

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Abstract: The UCX law (5 U.S.C. 8521-8523)* requires state workforce agencies (SWAs) to administer the UCX program in accordance with the same terms and conditions of the paying state's unemployment insurance law, which apply to unemployed claimants who worked in the private sector. Each state agency needs to obtain certain military service information on claimants filing for UCX benefits to enable them to determine his/her eligibility for benefits.

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Authorizing Statute(s): US Code: 5 USC 8523 Name of Law: Unemployment Compensation for Ex-Servicemembers
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 67355	12/28/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 31110	06/28/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Determination of Federal Military Service and Wages-UCX	ETA 841	Request for Determination of Federal Military Service and Wages—UCX
Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284	ETA 843	Request for Military Documentation for UCX

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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	2,711	107,816	0	-102,682	-2,423	0
Annual Time Burden (Hours)	226	2,139	0	-1,711	-202	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: ETA is removing ETA Form 841 from the list of UCX related forms, as states no longer use the form for data collection.

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Annual Cost to Federal Government: $42,661

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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Common Form ICR:  No

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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: 06/28/2019

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