Benefit Appeals Report

OMB 1205-0172

The ETA 5130, Benefit Appeals Report, contains information on the number of appeals and the resultant decisions classified by program, appeal level, cases filed and disposed of (workload flow), and decisions by level, appellant and issue. The data on this form are used to monitor the benefit appeals process in the state workforce agencies (SWAs). Data are also used for budgeting and workload data.

The latest form for Benefit Appeals Report expires 2023-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form ETA 5130 Benefit Appeals Report -- Extended Benefits (ETA 5130) Form and Instruction
Form ETA 5130 Benefit Appeals Report (ETA 5130 REG) Form and Instruction
1205-0172 Supporting Statement 050523 - Final.docx Supporting Statement A
Benefit Appeals Report -- Extended Benefits (ETA 5130) Form and Instruction
Benefit Appeals Report (ETA 5130 REG) Form and Instruction

All Historical Document Collections

202304-1205-005 Approved with change	Extension without change of a currently approved collection	2023-05-12
202001-1205-003 Approved without change	Extension without change of a currently approved collection	2020-05-18
201611-1205-004 Approved without change	Revision of a currently approved collection	2017-02-06
201305-1205-001 Approved with change	Extension without change of a currently approved collection	2014-01-22
201010-1205-003 Approved without change	Extension without change of a currently approved collection	2010-11-30
200709-1205-003 Approved without change	Extension without change of a currently approved collection	2007-10-09
200410-1205-001 Approved without change	Extension without change of a currently approved collection	2004-10-18
200108-1205-003 Approved without change	Extension without change of a currently approved collection	2001-08-16
199808-1205-003 Approved without change	Extension without change of a currently approved collection	1998-08-17
199506-1205-015 Approved without change	Revision of a currently approved collection	1995-06-27
199206-1205-001 Approved without change	Extension without change of a currently approved collection	1992-06-22
198906-1205-002 Approved without change	Extension without change of a currently approved collection	1989-06-27
198708-1205-003 Approved without change	Extension without change of a currently approved collection	1987-08-18
198606-1205-002 Approved without change	Extension without change of a currently approved collection	1986-06-03
198401-1205-004 Approved without change	Reinstatement with change of a previously approved collection	1984-01-17
198110-1205-012 Approved without change	New collection (Request for a new OMB Control Number)	1981-10-30

OMB Details

Benefit Appeals Report (ETA 5130 REG)

Federal Enterprise Architecture: Income Security - Unemployment Compensation

Form ETA 5130

BENEFIT APPEALS REPORT

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.