Information Collection

Reemployment and Eligibility Assessment Program

IC 13320 under ICR 202206-1205-007 · OMB 1205-0456.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0456 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9128 Reemployment and Eligibility Assessment Program	Form and Instruction
Form ETA 9128 RESEA Workload Reemployment and Eligibility Assessment Program	Form and Instruction
Form ETA 9129 RESEA Assessment Outcomes Reemployment and Eligibility Assessment Program	Form and Instruction
ETA 9128 RESEA Workload SectionIV_SpecialPrograms_ETA 9128 sof 6172022_clean copy.docx	Form and Instruction
ETA 9128 RESEA Workload SectionIV_SpecialPrograms_ETA 9128 sof 6172022_clean copy.docx	Form and Instruction
ETA 9129 RESEA Assessment Outcomes SectionIV_SpecialPrograms_ETA 9129.docx	Form and Instruction
ETA 9129 RESEA Assessment Outcomes SectionIV_SpecialPrograms_ETA 9129.docx	Form and Instruction
SectionIV_SpecialPrograms_ETA 9128 sof 6172022_tracked.docx 9128 Tracked Changes	IC Document
SectionIV_SpecialPrograms_ETA 9128 sof 6172022_tracked.docx 9128 Tracked Changes	IC Document

IC Title:

Reemployment and Eligibility Assessment Program

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 9128				Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9129				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	424	0	424
Annual IC Time Burden (Hours)	1,234	174	1,060
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
9128 Tracked Changes		06/30/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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