Information Collection Request

Benefits Timeliness and Quality Review System

ICR 202002-1205-002 · OMB 1205-0359 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form ETA 9057 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9056 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9055 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9054 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9052 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9051 Benefits Time Lapse and Quality Form and Instruction New Available
Form ETA 9050 Section V Benefits Time Lapse and Quality Form and Instruction Modified Available
signed_CEO Statistical Review Clearance Form_BTQ_2020_0121.pdf Supplementary Document Uploaded 2020-02-19 Available
1205-0359 Supporting Statement A 042720.docx Supporting Statement A Uploaded 2020-04-27 Available
1205-0359 Supporting Statement Part B 11-4-19 final (002).docx Supporting Statement B Uploaded 2020-02-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
240798 Form 9057 Form and Instruction NewBenefits Time Lapse and Quality
240796 ETA 9056 Form and Instruction NewBenefits Time Lapse and Quality
240795 ETA 9055 Form and Instruction NewBenefits Time Lapse and Quality
240794 ETA 9054 Form and Instruction NewBenefits Time Lapse and Quality
240793 Form 9052 Form and Instruction NewBenefits Time Lapse and Quality
240792 Form 9051 Form and Instruction NewBenefits Time Lapse and Quality
13147 Form 9050 Form and Instruction ModifiedSection V Benefits Time Lapse and Quality

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2023 36 Months From Approved 06/30/2020
23,740 0 28,356
37,012 0 37,812
0 0 0





Reginfo record details
7
table that charts list of burden
IC Title Form No. Form Name
ETA 9054 ETA 9054
ETA 9055 ETA 9055
ETA 9056 ETA 9056
Form 9050 ETA 9050
Form 9051 ETA 9051
Form 9052 ETA 9052
Form 9057 ETA 9057

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 23,740 28,356 0 -4,616 0 0
Annual Time Burden (Hours) 37,012 37,812 0 -800 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No