Benefit Appeals Report (ETA 5130 REG)

Benefit Appeals Report

Documents and Forms

Document Name Document Type
Form ETA 5130 Benefit Appeals Report (ETA 5130 REG) Form and Instruction
ETA 5130 BENEFIT APPEALS REPORT SectionI_ClaimantActivity_ETA 5130 030320 (1).docx Form and Instruction
ETA 5130 Benefit Appeals Report DOL-ETA 1205-0172 - ETA 5130 - 07.12.23 OCIO2.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Benefit Appeals Report (ETA 5130 REG)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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 5130	Benefit Appeals Report	DOL-ETA 1205-0172 - ETA 5130 - 07.12.23 OCIO2.docx		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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	636	636
Annual IC Time Burden (Hours)	636	636
Annual IC Cost Burden (Dollars)	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.