Information Collection

Claims and Payment Activities

IC 12927 under ICR 202412-1205-002 · OMB 1205-0010.

Documents and Forms

Document Name Document Type
Form ETA 5159 Claims and Payment Activities Form and Instruction
ETA 5159 Claims and Payment Activities SectionI_ClaimantActivity_ETA 5159.docx Form and Instruction
ETA 5159 Revised Claims and Payment Activity Copy of 5159.xlsx Form

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 and Instruction	ETA 5159	Claims and Payment Activities	SectionI_ClaimantActivity_ETA 5159.docx		Yes	Yes	Fillable Fileable
Form	ETA 5159	Revised Claims and Payment Activity	Copy of 5159.xlsx		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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,544	0	2,544
Annual IC Time Burden (Hours)	7,314	318	6,996
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.