Information Collection

Form 9050

IC 13147 under ICR 202002-1205-002 · OMB 1205-0359.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0359 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9050 Section V Benefits Time Lapse and Quality Form 9050	Form and Instruction
ETA 9050 Section V Benefits Time Lapse and Quality SectionV_Benefits_TimeLapse_and_Quality_ETA 9050_021920.docx	Form and Instruction

IC Title:

Form 9050

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9050				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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	636	-27,720	28,356
Annual IC Time Burden (Hours)	954	-36,858	37,812
Annual IC Cost Burden (Dollars)	0	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.

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