Experience Rating Report

OMB 1205-0164

The ETA-204 provides data to ETA for the study of seasonality, employment or payroll fluctuations, and stabilization, expansion or contraction in operations on employment experience. The data are used to provide an indication of whether solvency problems exist in the State's Trust Fund accounts and in analyzing factors that give rise to solvency problems. The data are also used to complete the Experience Rating Index.

The latest form for Experience Rating Report expires 2021-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form ETA 204 Experience Rating Report Form and Instruction
30-day FRN (1205-0164) published.pdf Supplementary Document
60-day FRN (1205-0164) published.pdf Supplementary Document
Supporting Statement 2021_OMB 1205-0164.docx Supporting Statement A
Experience Rating Report Form and Instruction

All Historical Document Collections

202108-1205-001 Approved without change	Extension without change of a currently approved collection	2021-09-28
201807-1205-004 Approved without change	Extension without change of a currently approved collection	2018-08-31
201506-1205-004 Approved without change	Extension without change of a currently approved collection	2015-06-22
201203-1205-002 Approved with change	Extension without change of a currently approved collection	2012-05-10
200910-1205-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-12-03
200901-1205-005 Approved without change	Extension without change of a currently approved collection	2009-03-27
200601-1205-001 Approved without change	Extension without change of a currently approved collection	2006-01-12
200212-1205-001 Approved without change	Extension without change of a currently approved collection	2002-12-09
199912-1205-002 Approved without change	Extension without change of a currently approved collection	1999-12-13
199611-1205-009 Approved without change	Reinstatement without change of a previously approved collection	1996-11-22
199311-1205-001 Approved without change	Reinstatement with change of a previously approved collection	1993-11-19
199007-1205-004 Approved without change	Revision of a currently approved collection	1990-07-30
198707-1205-002 Approved without change	Revision of a currently approved collection	1987-07-31
198507-1205-003 Approved without change	Extension without change of a currently approved collection	1985-07-03
198209-1205-003 Approved without change	Revision of a currently approved collection	1982-09-01
198110-1205-004 Approved without change	New collection (Request for a new OMB Control Number)	1981-10-29