Benefit Appeals Report

ICR 202304-1205-005

OMB: 1205-0172

Federal Form Document

Forms and Documents

Document Name	Status
Form ETA 5130 Benefit Appeals Report -- Extended Benefits (ETA 5130) Form and Instruction	Modified
Form ETA 5130 Benefit Appeals Report (ETA 5130 REG) Form and Instruction	Modified
1205-0172 Supporting Statement 050523 - Final.docx Supporting Statement A	2023-05-05

IC Document Collections

IC ID	Document Title	Status
239600	Benefit Appeals Report -- Extended Benefits (ETA 5130) Form and Instruction	Modified
13008	Benefit Appeals Report (ETA 5130 REG) Form and Instruction	Modified