OMB control number
Claims and Payment Activities
OMB 1205-0010 ยท DOL/ETA.
OMB 1205-0010
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.
The latest form for Claims and Payment Activities expires 2029-05-31 and is listed under ICR 202412-1205-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form ETA 5159 Revised Claims and Payment Activity | Form |
| Form ETA 5159 Claims and Payment Activities | Form and Instruction |
 Form ETA 5159 Claims and Payment Activities | Form and Instruction |
| Attachment B Changes to 5159-2.7.25.docx | Supplementary Document |
| Attachment B Changes to 5159-ks.docx | Supplementary Document |
 US DOL-ETA Agency Information Collection Activities; Comment Request; Claims and Payment Activities (Attn Kevin Stapleton).msg (document unavailable) | Public Comments |
| RE Information collection request on Claims and Payment Activities (Public Comment).msg (document unavailable) | Public Comments |
| RE Comment Information collection request on Claims and Payment Activities.msg (document unavailable) | Public Comments |
| 1205-0010 Supporting Statement_clean_2025.docx | Supporting Statement A |
| 1205-0010 Supporting Statement_12.19.24.docx | Supporting Statement A |
 Claims and Payment Activities |
Form |
| Claims and Payment Activities |
Form and Instruction |
| Claims and Payment Activities |
Form and Instruction |