Information Collection

Participant Disclosures to States

IC 201511 under ICR 202410-1205-008 · OMB 1205-0490.

Documents and Forms

Document Name Document Type
Form ETA-9161 Participant Disclosures to States Form and Instruction
ETA-9161 Self-Employment Assistance SectionIV_SpecialPrograms_ETA 9161 (2).docx 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	Self-Employment Assistance	SectionIV_SpecialPrograms_ETA 9161 (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,800	-4,800	13,600
Annual IC Time Burden (Hours)	4,400	-2,400	6,800
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.