Information Collection

Participant Disclosures to States

IC 201511 under ICR 201208-1205-005 · OMB 1205-0490.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0490 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9161 A,B,C Participant Disclosures to States Form and Instruction
ETA 9161 A,B,C Self EMployment Assistance reporting_instructions_ETA9161__SEA_final.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Disclosures to States	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 and Instruction	ETA 9161 A,B,C	Self EMployment Assistance	reporting_instructions_ETA9161__SEA_final.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,000	Number of Respondents for Small Entity: 24,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	72,000	72,000
Annual IC Time Burden (Hours)	36,000	36,000
Annual IC Cost Burden (Dollars)	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.