Participant Disclosures to States

Self-Employment Assistance (SEA) Program

Documents and Forms

Document Name Document Type
Form ETA-9161 Participant Disclosures to States Form and Instruction
ETA-9161 Self-Employment Assistance SectionIV_SpecialPrograms_ETA 9161.docx Form and Instruction
ETA-9161 Self-Employment Assistance SectionIV_SpecialPrograms_ETA 9161.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Participant Disclosures to States	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9161	Self-Employment Assistance	SectionIV_SpecialPrograms_ETA 9161.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,600	1,200	12,400
Annual IC Time Burden (Hours)	6,800	600	6,200
Annual IC Cost Burden (Dollars)	0	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.