Information Collection

Participant Disclosures to States

IC 201511 under ICR 202410-1205-008 · OMB 1205-0490.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9161 Participant Disclosures to States	Form and Instruction
Form ETA-9161 Self-Employment Assistance Participant Disclosures to States	Form and Instruction
ETA-9161 Self-Employment Assistance SectionIV_SpecialPrograms_ETA 9161 (2).docx	Form and Instruction
ETA-9161 Self-Employment Assistance SectionIV_SpecialPrograms_ETA 9161 (2).docx	Form and Instruction

IC Title:

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-9161				Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	8,800	-4,800	13,600
Annual IC Time Burden (Hours)	4,400	-2,400	6,800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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