Claims and Payment Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 5159 Revised Claims and Payment Activity	Form	Modified	Repair queued
Form ETA 5159 Claims and Payment Activities	Form and Instruction	Modified	Repair queued
Form ETA 5159 Claims and Payment Activities	Form and Instruction	Modified	Available
Attachment B Changes to 5159-2.7.25.docx	Supplementary Document	Uploaded 2025-02-07	Repair queued
Attachment B Changes to 5159-ks.docx	Supplementary Document	Uploaded 2024-12-19	Available
US DOL-ETA Agency Information Collection Activities; Comment Request; Claims and Payment Activities (Attn Kevin Stapleton).msg	Public Comments	Uploaded 2024-12-05	Repair queued
RE Information collection request on Claims and Payment Activities (Public Comment).msg	Public Comments	Uploaded 2024-12-05	Repair queued
RE Comment Information collection request on Claims and Payment Activities.msg	Public Comments	Uploaded 2024-12-05	Repair queued
1205-0010 Supporting Statement_clean_2025.docx	Supporting Statement A	Uploaded 2025-02-07	Repair queued
1205-0010 Supporting Statement_12.19.24.docx	Supporting Statement A	Uploaded 2024-12-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
12927	Claims and Payment Activities	Form	Modified	Revised Claims and Payment Activity
12927	Claims and Payment Activities	Form and Instruction	Modified	Claims and Payment Activities
12927	Claims and Payment Activities	Form and Instruction	Modified

ICR Details

OMB Control No: 1205-0010	ICR Reference No: 202412-1205-002
Status: Active	Previous ICR Reference No: 202112-1205-007
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Claims and Payment Activities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/08/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/15/2025
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2029	36 Months From Approved	05/31/2026
Responses	2,544	0	2,544
Time Burden (Hours)	7,314	0	6,996
Cost Burden (Dollars)	0	0	0

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Abstract: The Form ETA-5159 report provides important program information on claims taking and benefit payment activities under state/federal unemployment insurance laws. These data are needed for budget preparation and control, program planning and evaluation, personnel assignment, actuarial and program research, and for accounting to Congress and the public. This collection is authorized under the Social Security Act, Title III, Section 303(a)(6) and PL 112-96.

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Authorizing Statute(s): US Code: 42 USC 503(a)(6) Name of Law: Social Security Act
   PL: Pub.L. 112 - 96 2165(a)(3) Name of Law: Middle Class Tax Relief and Job Creation Act of 2012
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 55987	07/08/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 3962	01/15/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Claims and Payment Activities	ETA 5159, ETA 5159	Claims and Payment Activities ,   Revised Claims and Payment Activity

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,544	2,544	0	0	0	0
Annual Time Burden (Hours)	7,314	6,996	0	318	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The proposed changes will expand the number of data cells and nature of the data collected on payments and claims activities, which increases the time associated to program, populate, and submit the report(s) to ETA. This change in scope to the report is reflected in a slight increase in burden after consultation with multiple state workforce agencies’ reporting units. The additional changes to the report will increase the estimated burden of the regular ETA 5159 from 120 minutes to 150 minutes. The new data fields will allow the Department to conduct more program performance analysis and to implement a Government Accountability Office recommendation for the program office to collect data on the number of unique claimants, which is not currently a data element collected by the Unemployment Insurance Required Reports system.

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Annual Cost to Federal Government: $920,436

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/15/2025

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