Information Collection

Unemployment Insurance Title XII Advances and Voluntary Repayment Process

IC 43789 under ICR 202112-1205-010 · OMB 1205-0199.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0199 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
UIPL_July_2009.pdf	Instruction
UIPL_July_2009.pdf	Instruction

IC Title:

Unemployment Insurance Title XII Advances and Voluntary Repayment Process

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
Instruction					Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	57	54	3
Annual IC Time Burden (Hours)	57	54	3
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].