Information Collection

Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284

IC 43788 under ICR 201212-1205-010 · OMB 1205-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0176 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 843 Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284 Form and Instruction
ETA 843 Request for Military Documentation for UCX ETA 843 Form 2012.doc Form and Instruction
ETA 841 Request for Determination of Federal Military Service an ETA 841 2012.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Unemployment Compensation for Ex-servicemembers (UCX) - ETA Handbook 284	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 841	Request for Determination of Federal Military Service and Wages UCX	ETA 841 2012.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 843	Request for Military Documentation for UCX	ETA 843 Form 2012.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: 99 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,172	875	5,297
Annual IC Time Burden (Hours)	103	15	88
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.