View Information Collection (IC)

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-843	Request for Military Documentation for Unemployment Compensation Purposes	ETA 843 Form.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA-841	Request for Determination of Federal Military Service and Wages	ETA 841 Form.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	5,297	0	0	0	0	5,297
Annual IC Time Burden (Hours)	88	0	0	33	0	55
Annual IC Cost Burden (Dollars)	0	0	-37,000	0	0	37,000

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.