OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Certification Regarding Rights to Unemployment Benefits

IC 33878 under ICR 202606-3220-001 · OMB 3220-0079.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form UI-45 (11-16)
Claimant's Statement - Voluntary Leaving of Work Certification Regarding Rights to Unemployment Benefits		 Form
Form UI-45 (XX-XX)
Claimant's Statement - Voluntary Leaving of Work Certification Regarding Rights to Unemployment Benefits		 Form
UI-45 (11-16) Claimant's Statement - Voluntary Leaving of Work
Form UI-45 (11-16).pdf 		Form
UI-45 (XX-XX) Claimant's Statement - Voluntary Leaving of Work
Form UI-45 (XX-XX) Proposed.pdf 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 UI-45 (11-16) No   Paper Only
Form UI-45 (XX-XX) No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 176 0 0 -24 0 200
Annual IC Time Burden (Hours) 44 0 0 -6 0 50
Annual IC Cost Burden (Dollars) 0 0 0 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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