Benefit Appeals Report -- Extended Benefits (ETA 5130)

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⚠️ Notice: This information collection may be referencing outdated material.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 -- Extended Benefits (ETA 5130) Form and Instruction
ETA 5130 BENEFIT APPEALS REPORT SectionI_ClaimantActivity_ETA 5130 030320.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Benefit Appeals Report -- Extended Benefits (ETA 5130)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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	SectionI_ClaimantActivity_ETA 5130 030320.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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	636	636
Annual IC Time Burden (Hours)	636	636
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.