Information Collection

Request for Determination of Federal Military Service and Wages-UCX

IC 220501 under ICR 201906-1205-003 · OMB 1205-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0176 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 841 Request for Determination of Federal Military Service and Wages-UCX	Form
ETA 841 Request for Determination of Federal Military Service an ETA 841 Form_FINAL.doc	Form

IC Title:

Request for Determination of Federal Military Service and Wages-UCX

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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 841	Request for Determination of Federal Military Service and WagesâUCX	ETA 841 Form_FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 102,682

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-102,682	102,682
Annual IC Time Burden (Hours)	-1,711	1,711
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.