Benefit Accuracy Measurement, Individuals (Claimants)

UI Benefit Accuracy Measurement Program

Documents and Forms

Document Name Document Type
ET 395 5th edition.doc Instruction

Information Collection (IC) Details

IC Title:	Benefit Accuracy Measurement, Individuals (Claimants)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 603 20 CFR 601.5

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			ET 395 5th edition.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47,164	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	47,164	47,164
Annual IC Time Burden (Hours)	47,164	47,164
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.