Information Collection

Claims and Payment Activities

IC 12927 under ICR 201208-1205-004 · OMB 1205-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0010 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 5 159 Claims and Payment Activities Form
ETA 5 159 Claims and Payment Activities, Handbook 401 STC 5159 data map.docx Form
ETA 5159 Claims and Payment Activities Data map and reporting instructions for ETA 5159 1205-0010.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claims and Payment Activities	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 5 159	Claims and Payment Activities, Handbook 401	STC 5159 data map.docx		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 5159	Claims and Payment Activities	Data map and reporting instructions for ETA 5159 1205-0010.doc		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: 98 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,180	0	3,180
Annual IC Time Burden (Hours)	9,540	-25,440	34,980
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.