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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1205-0172
ICR Reference No:
201611-1205-004
Status:
Historical Active
Previous ICR Reference No:
201305-1205-001
Agency/Subagency:
DOL/ETA
Agency Tracking No:
UPI 012-05-01-05-01-2035-00
Title:
Benefit Appeals Report
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
05/18/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/06/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2020
36 Months From Approved
05/31/2017
Responses
1,272
0
1,908
Time Burden (Hours)
1,272
0
1,908
Cost Burden (Dollars)
0
0
0
Abstract:
The ETA 5130, Benefit Appeals Report, contains information on the number of appeals and the resultant decisions classified by program, appeal level, cases filed and disposed of (workload flow), and decisions by level, appellant and issue. The data on this form are used to monitor the benefit appeals process in the state workforce agencies (SWAs). Data are also used for budgeting and workload data.
Authorizing Statute(s):
US Code:
42 USC 503(a)(6)
Name of Law: Social Security Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 51941
08/05/2016
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 9399
02/06/2017
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Benefit Appeals Report
ETA 5130
Benefit Appeals Report
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
1,272
1,908
0
-636
0
0
Annual Time Burden (Hours)
1,272
1,908
0
-636
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
This ICR seeks no approval for discretionary actions affecting respondent burden. However, adjustments were made to reflect the expiration of Federal Emergency Unemployment Compensation Program, which occurred on January 1, 2014. DOL has refined the burden estimate entries for this collection, to make the relationship between reginfo.gov database information more consistent with the burden reported to respondents. As shown in item 12, each month States submit a separate ETA 5130 for each of the two programs and each form takes 1 hour to complete. The form provides that burden estimate. The database, however, reflected a single monthly response taking two hours.
Annual Cost to Federal Government:
$26,367
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Walter Parker 202 693-2778 parker.walter@dol.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
02/06/2017
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