Information Collection

Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers

IC 43787 under ICR 202501-1205-002 · OMB 1205-0162.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 191 Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers	Form
Form ETA 191 Statement of Expenditures and Financial Adjustments of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemember Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers	Form
SectionII_FundManagementActivity_ETA 191 clean copy_2025.docx	Instruction
SectionII_FundManagementActivity_ETA 191 clean copy_2025.docx	Instruction
ETA 191 Statement of Expenditures and Financial Adjustments of F ETA 191 508-compliant.pdf	Form
ETA 191 Statement of Expenditures and Financial Adjustments of F ETA 191 508-compliant.pdf	Form
SectionII_FundManagementActivity_ETA 191 - tracked.docx Tracked ETA 191 Instructions	IC Document
SectionII_FundManagementActivity_ETA 191 - tracked.docx Tracked ETA 191 Instructions	IC Document

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	ETA 191				Yes	Yes	Fillable Fileable
Instruction					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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	1,272	1,272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tracked ETA 191 Instructions		04/27/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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