Information Collection

Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers

IC 43787 under ICR 202204-1205-003 · OMB 1205-0162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0162 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 191 Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers Form
SectionII_FundManagementActivity_ETA 191.docx Instruction
SectionII_FundManagementActivity_ETA 191.docx Instruction
ETA 191 Statement of Expenditures and Financial Adjustments of F ETA 191 508-compliant.pdf Form
ETA 191 Statement of Expenditures and Financial Adjustments of F ETA 191 508-compliant.pdf Form
SectionII_FundManagementActivity_ETA 191 - tracked.docx Tracked ETA 191 Instructions IC Document
SectionII_FundManagementActivity_ETA 191 - tracked.docx Tracked ETA 191 Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement of Expenditures and Financial Adjustment of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemembers	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 191	Statement of Expenditures and Financial Adjustments of Federal Funds for Unemployment Compensation for Federal Employees and Ex-Servicemember	ETA 191 508-compliant.pdf		Yes	Yes	Fillable Fileable
Instruction			SectionII_FundManagementActivity_ETA 191.docx		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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	1,272	1,272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Tracked ETA 191 Instructions	SectionII_FundManagementActivity_ETA 191 - tracked.docx	04/27/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.